Clinical outcomes with hemivertebral filling during percutaneous vertebroplasty.
OBJECTIVE
Vertebroplasty has been commonly used for the treatment of vertebral compression fractures. Practitioners usually attempt to maximize filling of the vertebral body with polymethylmethacrylate (PMMA), either by using a bipediculate approach with separate infusions in both hemivertebrae or by using a unipediculate approach with central needle placement that allows bilateral hemivertebral filling. This study serves to investigate the clinical efficacy of a unipediculate approach in which the cement injected does not cross the midline, with resultant "hemivertebroplasty."


METHODS
A retrospective review of 917 vertebroplasty procedures was performed. A radiologic review of each vertebroplasty in the data base was performed to extract the vertebroplasties in which there was filling of only 1 side of the hemivertebra, which we term "hemivertebroplasty." Pre- and postoperative evaluations (1-week to 2-year postprocedure) included a Visual Analog Scale (VAS) for pain, the Roland-Morris Disability Questionnaire (RDQ) scores, and information regarding new fractures and retreatment of augmented fractures.


RESULTS
No significant difference was found between the hemivertebroplasty cases and the bilaterally filled vertebroplasty group in reducing VAS or RDQ scores. Moreover, survival analysis showed no significant difference in the risk of incident fracture between groups (hazard ratio = 0.81; 95% confidence interval, 0.33-2.65).


CONCLUSIONS
On the basis of our results, unilateral "hemivertebroplasty" is as effective in reducing pain with activity and at rest and decreasing the RDQ scores as bilateral vertebral filling. Additionally, vertebrae undergoing unilateral filling were at no greater risk of refracture or fracture of adjacent vertebrae than bilaterally filled vertebrae.
Knavel
E M
EM
University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Rad
A Ehteshami
AE
Thielen
K R
KR
Kallmes
D F
DF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001416:Back Pain / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy; D001843:Bone Cements; D005260:Female; D050815:Fractures, Compression / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019904:Polymethyl Methacrylate; D016016:Proportional Hazards Models; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D016896:Treatment Outcome; D054854:Vertebroplasty / Q000009:adverse effects / Q000379:methods*
D001843:Bone Cements; D019904:Polymethyl Methacrylate