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. 2014 Oct 31;20(5):564-75.
doi: 10.15274/INR-2014-10080. Epub 2014 Oct 17.

Retrospective review of procedural parameters and outcomes of percutaneous vertebroplasty in 673 patients

Benny S Kim  1 , Barbara Hum  2 , Jung Cheol Park  2 , In Sup Choi  2
Affiliations

Retrospective review of procedural parameters and outcomes of percutaneous vertebroplasty in 673 patients

Benny S Kim et al. Interv Neuroradiol. .

Abstract

Percutaneous vertebroplasty (PVP) is a minimally invasive procedure to treat back pain secondary to osteoporotic vertebral compression fractures (VCF). This study aims to review our techniques and outcomes in patients with VCF. Outcomes of all patients who underwent PVP at our institution from 1998 to 2014 were retrospectively collected from medical records and follow-up telephone interviews. 1174 PVP procedures for VCF in 673 patients were identified to have complete follow-up data. Patients with inadequate data were excluded from the analysis. Procedural aspects such as unipedicular or bipedicular access, vertebral region treated, amount of cement injected into vertebrae, number of levels treated at a single session, refracture rates and location, presence of a necrotic cavity, and pain outcomes were examined. Excellent rates of improvement of back pain for both single level and multilevel PVP were achieved in 92% of patients. Unipedicular or bipedicular approach, cement volume, vertebral region treated, cement extravasation, and presence of a necrotic cavity did not affect pain outcomes or refracture rates. Fractures that did develop after PVP were often adjacent and occurred earlier than distant level fractures. Lumbar vertebrae required more cement than thoracic vertebrae. PVP provides excellent rates of pain relief in both single and multilevel procedures. The procedural aspects evaluated did not affect pain outcome or refracture rates. Adjacent refractures tended to occur sooner than distant ones.

Keywords: compression fracture; vertebroplasty.

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Figures

Figure 1
Figure 1
Multilevel PVP at L1, L3, and L4. An 85 year old man underwent successful PVP for an L1 VCF, then developed recurrent lower back pain 6 weeks later and was found to have a refracture at L3 and L4. A) Frontal view of needle placement at L1 vertebral level prior to cement injection. B) Lateral view of L1 needle placement in same patient. Frontal (C) and lateral (D) views of lumbar spine following treatment of L3 and L4 level VCF. Note the uniform density of cement in L4 indicating filling of a necrotic cavity without trabeculation.
Figure 2
Figure 2
Cement extravasation at L3. A) Frontal view of cement extravasation in the perivertebral vein on the right. B) Frontal view of a separate patient with an L2 and L3 multilevel PVP with cement extravasation in the intervertebral disc space.
Figure 3
Figure 3
DynaCT rotational 3D image of L5 PVP. Coronal (A) and sagittal (B) reconstruction views of DynaCT. Note the location of cement cast in the necrotic cavity following burst fracture of L5. Lucency in the left side of the vertebral body indicates a residual cavity which is not filled with cement. No significant cement extravasation can be seen.
Figure 4
Figure 4
Distribution of cement used by vertebral level in 1174 procedures.
Figure 5
Figure 5
L3 PVP in Kummell's disease. A) Frontal view demonstrates a necrotic cavity at the inferior endplate of L3 which is more clearly seen on lateral (B) view. Complete cement placement in the necrotic cavity after PVP in frontal (C) and lateral (D) views.
See this image and copyright information in PMC

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