Pain relief following vertebroplasty in patients with and without localizing tenderness on palpation

Abstract

Background and purpose: Focal point tenderness over the fractured level is believed to be a necessary criterion for performing vertebroplasty. The purpose of this study was to explore whether the presence of focal-point tenderness over a fracture treated with vertebroplasty predicts superior clinical outcome as compared with outcomes in patients without such tenderness.

Materials and methods: In this retrospective study, we divided patients into 3 groups on the basis of pain patterns noted during history and physical examination before an initial vertebroplasty in 534 consecutive patients. Group 1 comprised 373 (70%) of 534 patients with focal-point tenderness over the treated fractures. Group 2 comprised 119 (22%) patients with focal-point tenderness over the treated fractures as well as subjective off-midline pain or focal tenderness to palpation over nontreated vertebrae. Group 3 comprised 42 (8%) patients without focal-point tenderness over the treated fractures but with subjective off-midline pain or tenderness to palpation over nontreated vertebrae. Outcomes included pain at rest and with activity as well as the Roland-Morris Disability Questionnaire score. Statistical tools included the 2-tailed t test with a Bonferroni adjustment.

Results: Baseline pain at rest and with activity was not different among groups, but the proportion of group 3 patients maintained on a narcotic anesthesia preprocedure was less than that of groups 1 and 2 (P = .02 compared with both groups). Group 3 achieved significantly lower pain scores at rest at 1 month (P < .0001 compared with group 1 and P < .001 compared with group 2).

Conclusion: The presence of focal-point tenderness does not predict superior clinical response following vertebroplasty compared with the absence of focal tenderness. Even patients without focal tenderness may benefit from vertebroplasty.

Fig 1.

Graph shows increasing vertebroplasties in patients without focal-point tenderness in our center. Asterisk indicates that data are from 2007, with patients included up to the end of February; Preop, preoperative.

Fig 2.

Graph shows pain score (1–10) at rest. Asterisk indicates significant difference compared with groups 1 and 2 (P = .0001 and .001, respectively); Preop, preoperative.

Fig 3.

Graph shows pain score (1–10) with activity.

Fig 4.

Graph shows modified Roland-Morris Disability Questionnarie (0–23) score.