title: Percutaneous vertebroplasty in very severe osteoporotic vertebral compression fractures: feasible and beneficial.
abstract: OBJECTIVE
  To assess clinical outcome and technical feasibility of percutaneous vertebroplasty (PVP) in 34 patients with 37 osteoporotic vertebral compression fractures (OVCFs) with vertebral body collapse to less than one-third of the original height, termed very severe osteoporotic vertebral compression fractures (vsOVCFs).
  
  
  METHODS
  A prospective follow-up study was conducted using a 0-10 pain intensity numerical rating scale and the Short Form-36 General Health Survey (SF-36) quality-of-life questionnaire, completed before PVP and 7 days (pain only), 1 month, 3 months, and 12 months after PVP. Cement leakage was analyzed on postoperative computed tomography (CT) scanning. The presence of new fractures was assessed at 6 weeks and 52 weeks and when suspected clinically.
  
  
  RESULTS
  Decrease in average and worst back pain was 2.5 points and 3.0 points after 7 days, and 2.5 points and 2.9 points after 12 months. The physical and mental SF-36 summary scores were significantly increased. Incidence of cement leakage in vsOVCFs was 91.9%, which was substantially higher compared with non-vsOVCFs (n = 40) treated in the same patients (64.1%; odds ratio [OR] 6.4, 95% confidence interval [CI] 1.7-24.5, P = .004). Mean leakage volume per treated vertebra was more than twice as high (0.80 mL vs 0.32 mL; P < .001). Seventeen new OVCFs in 11 patients (32.4%) were identified. Only one (2.9%) minor complication occurred, confirming the feasibility of PVP in vsOVCFs.
  
  
  CONCLUSIONS
  Patients with painful vsOVCFs can be treated with, and benefit from, PVP. Although technically more demanding and with a higher procedural risk (ie, more frequent necessity of placement of a second needle, higher leakage incidence, and greater leakage volumes), PVP is technically feasible and should not be withheld from these patients.
authors.affiliation: Department of Orthopedic Surgery, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, The Netherlands.
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Nieuwenhuijse
authors.forename: Arian R
authors.initials: AR
authors.lastname: van Erkel
authors.forename: P D Sander
authors.initials: PD
authors.lastname: Dijkstra
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001416:Back Pain / Q000209:etiology / Q000517:prevention & control; D016009:Chi-Square Distribution; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D050815:Fractures, Compression / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006801:Humans; D016014:Linear Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010024:Osteoporosis / Q000150:complications*; D010147:Pain Measurement; D018579:Patient Selection; D011446:Prospective Studies; D011788:Quality of Life; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D016103:Spinal Fractures / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D011795:Surveys and Questionnaires; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D054854:Vertebroplasty / Q000009:adverse effects