Percutaneous vertebroplasty for osteoporotic fractures.

BACKGROUND Vertebral augmentation has been widely used to treat vertebral body compression fractures caused by varied pathologies. The lifetime risk of a vertebral body compression fracture is 16% for women and 5% for men, and exponential increase of osteoporotic fractures worldwide. PURPOSE To determine the efficacy and durability of percutaneous vertebroplasty for the treatment of back pain associated with osteoporotic vertebral fractures. DESIGN A prospective study. MATERIALS AND METHODS A prospective evaluation of pain relief in 30 patients, with mean age of 73.7 years, who underwent percutaneous injection of polymethyl methacrylate into 54 vertebrae under fluoroscopic guidance over a period of 35 months was done. Before the procedure and at follow up, patients were asked to quantify their pain on a visual analogue scale. RESULTS The procedure was technically successful in all the patients. Mean duration of follow up was 21.5 months (6-44 months). Ninety-seven percent of the patients reported a significant relief 24 hours after the procedure. Ninety-two percent reported significant improvement in back pain, previously associated with a compression fracture, as well as improved ambulatory ability. Before vertebroplasty, the VAS score was 8.91+/- 1.82 compared to a score of 2.02+/- 1.95 at follow up. The mean difference in VAS score was significant (p<.0001). One patient had an asymptomatic epidural leak of PMMA, however did not require any further intervention. CONCLUSION Percutaneous vertebroplasty of symptomatic osteoporotic vertebral compression fractures is a minimally invasive procedure that provides immediate and sustained pain relief in patients with refractory pain.