Safety and efficacy of vertebroplasty: Early results of a prospective one-year case series of osteoporosis patients in an academic high-volume center.
BACKGROUND
Vertebroplasty (VP) is a cost-efficient alternative to kyphoplasty. However, it is considered inferior when it comes to maintaining safety and in vertebral body (VB) height restoration. We assess the safety and efficacy of VP in alleviating pain, improving quality of life (QoL), and restoring alignment.


METHODS
In a prospective monocenter case series, from April 2007 until July 2008, 1,422 vertebroplasties were performed, during 307 interventions, in 279 patients with traumatic, lytic, and osteoporotic fractures with 28 repeat interventions, for new fractures after the primary surgery, in 28 patients. The 226 interventions (n=203 patients) done for osteoporotic fractures were analyzed for demographics, treatment and radiographic details, pain alleviation, QoL improvement [NASS and Euroqol (EQ-5D)] and complications.


RESULTS
Osteoporotic patient sample consisted of 77.8% (n=158) females with a median age of 78 years and 45 males who had the same median age. Around 69% of these patients were ASA (American Society of Anesthesiologists) grade 3 and above. On an average there were 1.8 VBs fractured and five VBs treated,whereas the most frequently performed cementations were in six (35.6%, n=80) or five (19.6%, n=44) levels. About 36.5%, (n=414) of the interventions were localized at the thoraco-lumbar junction (Th12-L2). On applying the Genant classification, there was a slight height reduction in 13.1% (n=29), a medium loss in 34.3% (n=78), and a severe loss of height in 52.6% (n=119). The pre-operative pain was assessed by the visual analog scale (VAS) and decreased from 56.7 to 41.4 pts after two months. Accordingly, the QoL on the EQ-5D measure (0.6 to 1) improved from 0.32 pts before surgery to 0.58 pts after two months. The pre-operative Beck index (anterior height/posterior height) improved from a mean of 0.66 preoperative to 0.80 post-operative and remained stable at two months post-operatively. There were cement leakages in 33% of the fractured VBs and in 0.8% of the prophylactically cemented VBs; there were symptoms in 7.1%, and most of them were temporary hypotension and one pulmonary cement embolism that remained asymptomatic.


CONCLUSIONS
If routinely used, VP is a safe and efficient treatment option for osteoporotic vertebral fractures with regard to pain relief and improvement of the QoL. Even segmental re-alignment can be achieved to a certain extent with proper patient positioning.
Diel
Peter
P
Spine Service, Inselspital Bern, Switzerland.
Merky
Dominique
D
Röder
Christoph
C
Popp
Albrecht
A
Perler
Malgorzata
M
Heini
Paul Ferdinand
PF