Percutaneous vertebroplasty: optimizing the procedure after treatment of 250 vertebral levels under fluoroscopic guidance.
OBJECTIVE
Percutaneous vertebroplasty (PVP) is a minimally invasive treatment for symptomatic vertebral compression fractures (VCFs). The aim of this study was to assess the effectiveness, complications and progress of results of PVP optimized in terms of technique, costs, time and strategic protocol after 3 years of procedures performed under fluoroscopic guidance alone.


METHODS
We treated 250 VCFs in 120 consecutive patients after assessing clinical and radiological indications. The effectiveness of the procedure was determined by statistical analysis of numerical scores for pain, mobility and drug consumption before and after treatment.


RESULTS
No major complications and only three minor complications occurred. Clinically relevant improved mobility and reduction of pain and analgesics were observed, with overall significant results (p<0.0001) in all patients at 24 h after PVP and in 83 available patients at 6 months. A total of five asymptomatic refractures of cemented vertebrae and 14 new symptomatic vertebral fractures at different levels were observed between 1 and 10 months after the procedure.


CONCLUSIONS
PVP is a safe, rapid, effective and costeffective therapy for VCFs, requiring only brief hospital admission and with long-lasting clinical results, when performed under good-quality radiological guidance, when correct indications are respected and when it is associated with rehabilitation therapy in the follow-up. It is a valid alternative to conservative therapy, which is burdened by high healthcare costs and often requires long-term immobilisation of frail and elderly patients at risk of clinical complications.
Dipartimento di Bioimmagini e Scienze Radiologiche, Università Cattolica del Sacro Cuore, Policlinico A. Gemelli, Rome, Italy. apedicelli@rm.unicatt.it
A
A
Pedicelli
M
M
Rollo
M
M
Piano
G
G
Grattacaso
C
C
Colosimo
L
L
Bonomo
D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements / Q000627:therapeutic use; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods; D050815:Fractures, Compression / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods; D010024:Osteoporosis / Q000150:complications; D010147:Pain Measurement / Q000379:methods; D010779:Photofluorography / Q000379:methods; D011788:Quality of Life; D015641:Radiography, Interventional; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D016103:Spinal Fractures / Q000000981:diagnostic imaging* / Q000209:etiology / Q000534:rehabilitation / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods; D013125:Spinal Neoplasms / Q000150:complications; D013131:Spine / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome; D054854:Vertebroplasty / Q000379:methods*
D001843:Bone Cements