title: Intrasomatic injection of corticosteroid followed by vertebroplasty increases early pain relief rather than vertebroplasty alone in vertebral bone neoplasms: preliminary experience.
abstract: OBJECTIVE
  In this prospective multicenter study, we evaluate the effectiveness of corticosteroid plus vertebroplasty rather than vertebroplasty alone in the analgesic treatment of single-level vertebral neoplasms or pathological fractures.
  
  
  METHODS
  From January 2009 to February 2011, we prospectively enrolled 20 consecutive patients (11 women, nine men; age range 46-78 years; mean age 65.1 years) with single-level vertebral neoplasm or pathological fractures totally or partially refractory to analgesic treatment, with indication to vertebroplasty. Institutional review board approval and informed consent were obtained. The inclusion criteria for the study were the presence of a single-level pathological fracture not extended to the posterior wall or symptomatic localization of primary or secondary neoplasms, visual analogue score (VAS) ≥5, and life expectancy more than 3 months. Exclusion criteria where all contraindications either to corticosteroid injection included allergy (local sepsis, bacteremia, allergy) or vertebroplasty included coagulopathy, etc. The population was randomly divided into two groups: in group A, patients underwent intrasomatic injections of 4 mg/ml of dexamethasone phosphate followed by a cement injection; patients in group B underwent standard vertebroplasty. VAS score was evaluated and compared between both groups of patients at 6 h, 24 h, 48 h, 7 days, 30 days, and 3 months after the intervention plus last available follow-up. Statistical analyses were performed by application of the t test.
  
  
  RESULTS
  Technical success was achieved in all cases. In group A, we treated six male and six female patients (age range 46-73 years, average 60.2 years). Pre-intervention VAS in group A ranged between 7 and 10 points, average 8 points. In group B, we treated three male and five female patients (age range 52-78 years, average 67.3 years). Pre-intervention VAS score in group B ranged between 7 and 9 points, with an average 8 points. Patients in group A in respect to patients in group B had a higher reduction in VAS, with a difference of 25.4% (VAS reduction average 5.5 versus 4.1) at 6 h post-intervention, 24.5% (VAS average 5.7 versus 4.3) at 24 h, 25% (VAS average 6 versus 4.5) at 48 h, 23% (VAS average 6.5 versus 5) at 7 days, 16.4% (VAS average 6.7 versus 5.6) at 30 days, 8.9% (VAS average 6.7 versus 6, .1) at 3 months. The last available follow-up ranged from 3 to 24 months in group A and from 5 to 20 months in group B.
  
  
  CONCLUSIONS
  In our preliminary experience, pre-vertebroplasty injection of intrasomatic corticosteroid in comparison to vertebroplasty alone is able to increase the early pain relief of the procedure.
authors.affiliation: Department of Diagnostic and Interventional Radiology, Ospedale Garibaldi Centro, Piazza Santa Maria del Gesù, Via Trieste 14, 95127, Catania, Italy. antodoc@yahoo.com
authors.forename: Antonio
authors.initials: A
authors.lastname: Basile
authors.forename: Salvatore
authors.initials: S
authors.lastname: Masala
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Banna
authors.forename: Elisa
authors.initials: E
authors.lastname: Cotta
authors.forename: Maide
authors.initials: M
authors.lastname: Cavalli
authors.forename: Paolo
authors.initials: P
authors.lastname: Fiumara
authors.forename: Francesco
authors.initials: F
authors.lastname: Di Raimondo
authors.forename: Elena
authors.initials: E
authors.lastname: Mundo
authors.forename: Giovanni
authors.initials: G
authors.lastname: Scavone
authors.forename: Antonio
authors.initials: A
authors.lastname: Granata
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Carrafiello
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Tsetis
mesh_terms: D000368:Aged; D001416:Back Pain / Q000209:etiology* / Q000628:therapy*; D001843:Bone Cements / Q000627:therapeutic use; D003907:Dexamethasone / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D005598:Fractures, Spontaneous / Q000150:complications* / Q000628:therapy*; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D010148:Intractable Pain / Q000209:etiology / Q000628:therapy; D011446:Prospective Studies; D013125:Spinal Neoplasms / Q000150:complications* / Q000628:therapy*; D054854:Vertebroplasty
chemical_list: D001843:Bone Cements; D005938:Glucocorticoids; D003907:Dexamethasone
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