Treatment of painful compression vertebral fractures with vertebroplasty: results and complications

Abstract

Aim: The aim of this paper is to assess the effectiveness and safety of percutaneous vertebroplasty in patients with focal pain caused by compression vertebral body fractures.

Materials and methods: Over an eleven-month period 49 patients underwent percutaneous vertebroplasty, of which seven were retreated, for a total of 56 operations on 108 vertebrae. The patients were affected by osteoporotic compression fractures (n=28) or by benign and malignant infiltrative processes (n=21). All of the patients were examined at discharge and later at one week, and one, three, six and nine months after surgery to ascertain the development of the pain and possible changes in the quality of life. The mean length of follow-up was 3.8 months.

Results: One week after treatment all patients reported complete disappearance or significant alleviation of the pain. In 8 out of 49 patients (16.3%) there was a reoccurrence of pain; 7 of these patients underwent further treatment at another level with immediate pain relief. After surgery only three patients (6.1%) continued to take non-steroidal anti-inflammatory drugs (NSAIDs), whereas prior to surgery all patients were taking pain medication. We also observed an important benefit in the quality of life, in that after treatment all patients reported an improvement in functional abilities, and only three (6.1%) still had to wear a back brace (against 15 in the preoperative period). We only had one serious complication (1.7%) which involved the formation of a subcutaneous paravertebral haematoma, which was resolved in about a week. Eight patients (16.3%) developed transient pain at the site of the puncture or radiculopathy in the days following the operation. In 63 out of 108 of the treated vertebrae (58) there were small asymptomatic leakages of cement outside the vertebral body and in two asymptomatic patients (3.5%) the chest radiograph revealed a small pulmonary embolism of cement.

Discussion: Our experience confirms the effectiveness of vertebroplasty in the treatment of pain caused by vertebral fractures. If the indications are respected the improvement of symptoms is often immediate, such as the return of mobility, and patient satisfaction with surgery is higher. The use of appropriate guiding systems limits the number of complications.