Vertebroplasty in the treatment of osteoporotic spine fractures

Author(s): DANIEL ZARZYCKI, TOMASZ POTACZEK, MACIEJ TĘSIOROWSKI, KRZYSZTOF ŁOKAS

Introduction: Vertebroplasty is a direct injection of bone cement into a fractured vertebral body. The main goal of the procedure is reduction of pain. The method is used most frequently in the treatment of osteoporotic compressive vertebral fractures, vertebral haemangioma or systemic diseases affecting vertebral bodies. Aim of paper: The aim of this paper is to evaluate the results of treatment of osteoporotic vertebral bodies compressive fractures with percutaneous vertebroplasty technique. Material and methods: Material consists of 61 patients, 44 women and 17 men. Altogether 70 surgical procedures were performed, bone cement was injected into 86 vertebral bodies. Diagnosis: primary osteoporosis – 40 patients, secondary – 2, myeloma multiplex – 2, haemangioma – 13, metastases – 3, cystic fibrosis – 1. Only patients with compressive vertebral bodies fractures in the course of primary osteoporosis were evaluated (38 women, 2 men). In this group 47 surgical procedures were performed, bone cement was applied into 60 vertebral bodies. The most frequently affected bodies were Th11 and L1 – 15 fractures each. Mean time lap from injury to the surgical intervention was 6 weeks (2 weeks – 6 months). Mean age at surgery was 69 years (51 – 80 years). We evaluated the subjective pain intensity using the VAS system, prior to surgery, directly after surgery and at follow-up. Above that we evaluated the course of surgery, presence of early and late complications. Mean follow-up period was 43 months (12 – 68 months). Results: Before surgery the mean VAS score was 7.7 (6 – 9), directly after surgery 2.7 (0 -9) and at follow-up 2.9 (0 – 6). Intraoperative complications occurred in two cases – cement leakage into the spinal canal. In one case due to partial lower limb paresis revision surgery was required. In the other case no neurological deficits were noted. In case of other 4 patients cement leakage in the ventral direction was noted, without clinical manifestations. No embolic complications were noted. In three cases adjacent vertebral bodies compressive fractures were noted in the period less than 3 months from surgery. Conclusion: Vertebroplasty is an effective method in the treatment of pain following vertebral compressive osteoporotic fractures. The number of complications is low, but they might have very serious consequences.