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Treatment of chronic symptomatic vertebral compression fractures with percutaneous vertebroplasty
Daniel B Brown1, Louis A Gilula, Manu Sehgal
1Mallinckrodt Institute of Radiology, 510 S Kingshighway Blvd, Box 8131, St Louis, MO 63110, USA. brownda@mir.wustl.edu
Insights
Percutaneous vertebroplasty offers clinical benefits for chronic vertebral fractures over one year old. While pain relief is common, complete pain resolution is more likely with less mature fractures.
Area of Science:
- Orthopedics
- Neurosurgery
- Radiology
Background:
- Percutaneous vertebroplasty is commonly used for subacute vertebral fractures (<1 year old).
- The efficacy of vertebroplasty for chronic vertebral fractures (>1 year old) is less established.
Purpose of the Study:
- To evaluate the effectiveness of percutaneous vertebroplasty in treating chronic vertebral fractures.
- To compare outcomes in patients with fractures older than one year to those with fractures less than one year old.
Main Methods:
- Retrospective analysis of 41 patients with symptomatic vertebral fractures >1 year old.
- Fractures were categorized by age: 12-24 months and >24 months.
- Outcomes (pain, mobility) were compared to 49 control patients with fractures <1 year old.
Main Results:
- 80% of patients with chronic fractures experienced pain improvement (17% complete, 63% partial).
- Mobility improved in 49% of the chronic fracture group vs. 69% in the control group (p=0.047).
- Fractures >24 months old showed significantly less mobility improvement (p=0.006).
Conclusions:
- Percutaneous vertebroplasty provides clinical benefits for most patients with chronic vertebral fractures.
- Treatment of less mature fractures (12-24 months) yields mobility improvements comparable to acute fractures.
Objective:
Most fractures treated with percutaneous vertebroplasty are subacute and less than 1 year old. We report our experience treating chronic vertebral fractures with vertebroplasty.
Materials And Methods:
Our database identified 41 patients with symptomatic fractures more than 1 year old. These patients were categorized into subgroups determined by fracture age: 12 months 1 day-24 months (n = 16) or more than 24 months 1 day (n = 25). Changes in pain and mobility for the study group were compared with those in 49 patients with fractures less than 1 year old.
Results:
Thirty-three (80%) of the 41 patients in the study group had improvement in pain-seven (17%) had complete and 26 (63%) had partial relief. Forty-five (92%) of the 49 control group patients had improvement in pain-24 (49%) had complete and 21 (43%) had partial relief. The number of patients achieving partial or complete relief of pain was not statistically different between groups (p > 0.05), although complete relief was significantly more frequent in the control group (p = 0.002). Twenty patients (49%) in the study group versus 34 patients (69%) in the control group had improved mobility after vertebroplasty (p = 0.047). Patients with fractures 12 months 1 day-24 months old had improvement in mobility similar to that in patients in the control group (p = 0.962). Fractures more than 24 months 1 day old were associated with significantly less improvement in mobility (p = 0.006).
Conclusion:
Most patients with fractures more than 1 year old will experience clinical benefit from vertebroplasty. Complete relief of pain is more likely when less mature fractures are treated.
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