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Midterm outcome after vertebroplasty: predictive value of technical and patient-related factors
Juerg Hodler1, Dallas Peck, Louis A Gilula
1Mallinckrodt Institute of Radiology, Washington University Medical Center, 510 S Kingshighway Blvd, St Louis, MO 63110-1076, USA.
Purpose:
To evaluate different types of polymethylmethacrylate (PMMA) leakage and patient-related factors in relation to clinical midterm (1-24-month) outcome after vertebroplasty.
Materials And Methods:
Standardized four-view radiographs obtained during 363 vertebroplasties in 181 treatment sessions in 152 patients were reviewed (121 patients with osteoporotic fractures, 30 with malignant disease, and one with hemangioma). Four types of PMMA leakage and other potential predictors (patient age and sex, treated region, number of vertebral levels injected, preprocedural pain, PMMA volume per vertebra) were related to postprocedural pain response and midterm outcome after vertebroplasty. chi2 and Kruskal-Wallis tests were used for statistical analysis. The mean follow-up period was 8.8 months (range, 1-24 months).
Results:
At the time of discharge after the procedure, pain was absent after 106 of the 181 sessions (58.5%), better after 50 (27.6%), and the same after 25 (13.8%). In 258 of the 363 treated vertebral levels, at least one type of leakage was found. None of the evaluated factors were related significantly to postprocedural pain response, including PMMA leakage. Pain response at midterm outcome was strongly related to postprocedural treatment success, however (P <.001).
Conclusion:
Small to moderate amounts of PMMA may escape from the vertebral body with no significant effect on therapeutic success. Immediate postprocedural pain relief is the best predictor of midterm clinical outcome after vertebroplasty.
Insights
Polymethylmethacrylate (PMMA) leakage during vertebroplasty does not significantly impact midterm outcomes. Immediate pain relief after the procedure is the strongest predictor of successful long-term clinical results.
Area of Science:
- Interventional Radiology
- Orthopedic Surgery
- Spinal Procedures
Background:
- Vertebroplasty is a common procedure for treating vertebral compression fractures.
- Polymethylmethacrylate (PMMA) is frequently used as bone cement in vertebroplasty.
- Understanding factors influencing clinical outcomes is crucial for patient management.
Purpose of the Study:
- To assess the impact of PMMA leakage and patient factors on midterm outcomes after vertebroplasty.
- To identify predictors of clinical success following vertebroplasty.
Main Methods:
- Review of 363 vertebroplasties in 152 patients, analyzing PMMA leakage types and patient-related factors.
- Statistical analysis using chi-squared and Kruskal-Wallis tests.
- Evaluation of midterm outcomes (1-24 months) including pain response.
Main Results:
- PMMA leakage was observed in a significant number of procedures but did not correlate with postprocedural pain response.
- No evaluated factors, including PMMA leakage, significantly predicted immediate pain relief.
- Pain response at midterm was strongly associated with immediate postprocedural treatment success.
Conclusions:
- Small to moderate PMMA leakage does not adversely affect therapeutic success in vertebroplasty.
- Immediate pain relief following vertebroplasty is the most reliable indicator of midterm clinical outcomes.
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