Vertebroplasty, first 1000 levels of a single center: evaluation of the outcomes and complications

Abstract

Background and purpose: Percutaneous polymethylmethacrylate (PMMA) vertebroplasty has become a common procedure for treatment of pain and disability associated with vertebral compression fractures. We reviewed the experience with our first 1000 consecutively treated vertebral compression fractures in an attempt to demonstrate both the short- and long-term safety and efficacy of percutaneous vertebroplasty.

Materials and methods: The first 1000 compression fractures treated by vertebroplasty at our institution were identified from a comprehensive prospectively acquired vertebroplasty data base. All patients treated with vertebroplasty were included, regardless of the underlying pathologic cause. Chart reviews of the procedure notes, imaging studies, clinical visits, and follow-up telephone interviews were performed for each patient. Evaluation at each follow-up time point included pain response (subjective and visual analog pain score), change in mobility, change in pain medication usage, and modified Roland-Morris Disability Questionnaire. Statistical analysis was performed on the pain response and change in the Roland-Morris score at each follow-up time point. Significant procedure-related complications that occurred from the time of the procedure were also specifically extracted from the patients' charts.

Results: There was a dramatic improvement in all the evaluated parameters following percutaneous vertebroplasty. The improvement in pain, mobility, medication usage, and Roland-Morris score was noticed immediately after the procedure and persisted through the 2-year follow-up. There was a low rate of complications from the procedure, the most common being rib fractures.

Conclusion: According to our results, practitioners can quote a high success rate and low complication rate for vertebroplasty when making treatment recommendations for painful spinal compression fractures.

Fig 1.

Number of procedures performed with the patient under general anesthesia with time.

Fig 2.

Distribution of treated compression fractures.

Fig 3.

Pain relief following vertebroplasty by using the visual analog pain scale.

Fig 4.

Comparison of the average Roland-Morris score before and after vertebroplasty.

Fig 5.

Visual analog pain score changes in the subset of patients who did not experience any pain relief at the 2-hour postprocedure evaluation. Despite no pain relief at 2 hours, these patients experienced significant pain relief at the remaining follow-up time points up to 2 years.

Fig 6.

Distribution of cases with cement leakage outside the vertebral body.