title: Predictors of successful palliation of compression fractures with vertebral augmentation: single-center experience of 525 cases.
abstract: OBJECTIVE
  To determine the effectiveness of vertebral augmentation in relieving pain, differences in pain relief outcomes based on procedure type were investigated. Variables that potentially influence outcomes were identified.
  
  
  METHODS
  A database of 525 cases (740 levels) treated for compression fractures with vertebroplasty, kyphoplasty, or S1-level sacroplasty was compiled. Average age was 75 years +/- 12, and 72.4% of patients were female. Variables evaluated included age, sex, fracture etiology, procedure type, vertebral level treated, number of levels treated per procedure, and technical approach. Outcomes were assessed by a binary system of "responders" (ie, patients with improvement/resolution of pain) versus "non-responders" (ie, those with no change/worsening of pain) and with a four-level pain scale (1, pain resolution; 2, pain improvement; 3, no change; 4, worse pain) retrospectively applied from medical records. Univariate and multivariate analyses determined outcomes.
  
  
  RESULTS
  Four-hundred and sixty-seven patients (89%) showed a response to treatment: 40% had pain resolution and 49% had pain improvement. Multivariate analysis showed that women and older patients had greater odds of being responders (odds ratios [ORs], 0.56 and 0.98, respectively; P = .016 and P = .048, respectively). Patients without cancer (OR, 1.60; P = .012) and women (OR, 2.05; P = .0002) were more likely to experience pain resolution. Increasing numbers of levels treated per case were associated with decreased odds of pain resolution (OR, 0.69; P = .0081). Sex and number of levels treated were independently predictive of pain scale outcomes (ORs, 2.0 and 0.71, respectively; P = .0003 and P = .015).
  
  
  CONCLUSIONS
  Vertebral augmentation procedures provide pain relief for a majority of patients regardless of underlying fracture etiology. There was no difference in pain outcomes among procedure types. Age and sex may be predictive of pain outcomes.
authors.affiliation: Department of Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA. rjha@partners.org
authors.forename: Ruchira M
authors.initials: RM
authors.lastname: Jha
authors.forename: Albert J
authors.initials: AJ
authors.lastname: Yoo
authors.forename: Ariel E
authors.initials: AE
authors.lastname: Hirsch
authors.forename: Marion
authors.initials: M
authors.lastname: Growney
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Hirsch
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001416:Back Pain / Q000453:epidemiology* / Q000517:prevention & control*; D001900:Boston / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D050815:Fractures, Compression / Q000453:epidemiology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000706:statistics & numerical data*; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D017678:Sex Distribution; D016103:Spinal Fractures / Q000453:epidemiology* / Q000628:therapy*; D016896:Treatment Outcome; D054854:Vertebroplasty / Q000706:statistics & numerical data*