title: Pain relief following vertebroplasty in patients with and without localizing tenderness on palpation.
abstract: OBJECTIVE
  Focal point tenderness over the fractured level is believed to be a necessary criterion for performing vertebroplasty. The purpose of this study was to explore whether the presence of focal-point tenderness over a fracture treated with vertebroplasty predicts superior clinical outcome as compared with outcomes in patients without such tenderness.
  
  
  METHODS
  In this retrospective study, we divided patients into 3 groups on the basis of pain patterns noted during history and physical examination before an initial vertebroplasty in 534 consecutive patients. Group 1 comprised 373 (70%) of 534 patients with focal-point tenderness over the treated fractures. Group 2 comprised 119 (22%) patients with focal-point tenderness over the treated fractures as well as subjective off-midline pain or focal tenderness to palpation over nontreated vertebrae. Group 3 comprised 42 (8%) patients without focal-point tenderness over the treated fractures but with subjective off-midline pain or tenderness to palpation over nontreated vertebrae. Outcomes included pain at rest and with activity as well as the Roland-Morris Disability Questionnaire score. Statistical tools included the 2-tailed t test with a Bonferroni adjustment.
  
  
  RESULTS
  Baseline pain at rest and with activity was not different among groups, but the proportion of group 3 patients maintained on a narcotic anesthesia preprocedure was less than that of groups 1 and 2 (P = .02 compared with both groups). Group 3 achieved significantly lower pain scores at rest at 1 month (P < .0001 compared with group 1 and P < .001 compared with group 2).
  
  
  CONCLUSIONS
  The presence of focal-point tenderness does not predict superior clinical response following vertebroplasty compared with the absence of focal tenderness. Even patients without focal tenderness may benefit from vertebroplasty.
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: A Ehteshami
authors.initials: AE
authors.lastname: Rad
authors.forename: D F
authors.initials: DF
authors.lastname: Kallmes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D005260:Female; D018460:Fractures, Comminuted / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D010147:Pain Measurement; D010166:Palliative Care; D010173:Palpation; D011379:Prognosis; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome; D054854:Vertebroplasty