Influence of Vertebral Bone Marrow Edema on Outcome in Non-Acute Osteoporotic Patients Treated with Percutaneous Vertebroplasty

Abstract

Study design: Prospective cohort study.

Purpose: To prospectively investigate the influence of presence of bone marrow edema (BME) in non acute osteoporotic verterbral compression fractures on postoperative clinical outcome in patients treated by percutaneous vertebroplasty (PV).

Overview of literature: Although PV is widely used to treat osteoporotic collapsed vertebral compression fractures (VCF); little is known about the influence of BME in osteoporotic VCF or about its relation with relief of pain.

Methods: Sixty seven patients with non acute osteoporotic verterbral compression fractures treated with PV. They were divided into edema group (56 patients with apparent vertebral BME in their magnetic resonance [MR] images), and non edema group (11 patients with no vertebral BME detected in their MR images). Pain was evaluated one week, one month, six months, and one year post procedure using visual analogue scale. Statistical analysis including a 2-tailed t test comparing postoperative data with preoperative values was done.

Results: A good clinical response to PV procedure was seen in all patients. Significant difference was seen between two groups in one week, and one month follow up periods. Regarding pain relief in the other periods of follow up, no significant difference was seen between two groups.

Conclusions: PV resulted in significantly clinical improvement in patients with BME pattern than in those without in one week and one month follow up periods. But the absence of vertebral BME did not influence pain relief in patients with osteoporotic VCFs in six months, and one year post procedure.

Keywords: Bone marrow edema; Non acute spinal fractures; Osteoporotic vertebral fractures; Percutaneous vertebroplasty.

Fig. 1. T1 weighted magnetic resonance sagittal image of a patient with edema group type 1 (bone marrow edema more than 50%).

Fig. 2. T1 weighted magnetic resonance sagittal image of a patient with osteoporotic vertebral compression fracture of L1, edema group type 2 (bone marrow edema less than 50%).

Fig. 3. T2 weighted magnetic resonance sagittal image of a patient with osteoporotic vertebral compression fracture of L2, non edema group type 3 (no bone marrow edema).

Fig. 4. Graph showing pain at rest and during activity preoperatively and following percutaneous vertebroplasty in all three subgroups at follow up intervals (p<0.001). Preop., preoperative. ^a)paired t test; ^b)Wilcoxon signed test.

Fig. 5. Graph showing percentage of medication usage before and after percutaneous vertebroplasty in all three subgroups at follow up intervals (p<0.001) (Wilcoxon paired sample test). NSAID, nonsteroidal anti-inflammatory drugs; Preop., preoperative.

Fig. 6. Graph showing percentage of improvement in mobility following percutaneous vertebroplasty in all three subgroups at follow up intervals (p<0.002) (chi-square test).