Vertebroplasty Technique for Osteoporosis Spinal Fractures

The use of vertebroplasty as a treatment for vertebral compression fractures helps patients with both pain relief and everyday mobility, according to a new five-year follow-up study of over 800 osteoporosis patients. Results were detailed at the Society of Interventional Radiology‘s 33rd Annual Scientific Meeting.

Vertebroplasty is a procedure in which medical-grade bone cement is injected into a fractured vertebra, in order to reinforce the fracture. It is a sort of internal cast, and provides pain relief. Vertebroplasty is best used for painful vertebral compression fractures which do not respond to standard medical therapy, such as pain relief with analgesics or narcotic doses. The average pre-treatment pain score on the 11-point Visual Analog Scale was 7.9 +/- 1.5. It dropped to an average of 1.3 +/- 1.8 after the vertebroplasty treatment.

Ability to cope with everyday life tasks, such as washing, standing or dressing, was measured by the commonly used Oswestry Disability Questionnaire (ODQ), which was completed by patients before — and again one month after–vertebroplasty. The ODQ scores changed from an average of 69.3 percent +/- 13.5 to 18.8 percent +/- 6.9, showing a highly significant improvement in mobility.

“These data provide good news for physicians and osteoporosis patients. Many osteoporosis patients with compression fractures are in terrible pain and have a greatly diminished ability to perform basic daily activities, such as dressing themselves,” noted Giovanni C. Anselmetti, M.D., interventional radiologist at the Institute for Cancer Research and Treatment in Turin, Italy.

Vertebroplasty can greatly improve one’s quality of life; however, the treatment is generally reserved for patients who have failed conventional medical management.

“Osteoporosis patients who have persistent spinal pain lasting more than three months should consult an interventional radiologist, and those who require constant narcotic pain relief should seek help immediately,” said Anselmetti.

Treatment was completed in all patients without major complications and with good clinical results. The data add to the body of evidence[1,2] in the United States for the minimally invasive treatment’s safety, effectiveness and low-complication rate. The treatment is widely available in the United States at all major institutions and many smaller institutions and is generally covered by health insurance.

The study also showed that vertebroplasty does not increase the risk of fracture in nearby vertebra. “Vertebroplasty is already known to be a safe and effective treatment for osteoporotic vertebral fractures. Osteoporosis patients remain susceptible to new fractures, which often occur in the contiguous vertebra to an existing fracture. Our large-scale study shows that vertebroplasty does not increase the risk of fracture in the level contiguous to previously treated vertebra and that these new fractures occur at the same rate as they would in osteoporosis patients who did not have vertebroplasty,” added Anselmetti.

Vertebroplasty History

Vertebroplasty was first performed in France in 1984 to treat compression fractures caused by bone cancer or bone metastasis and later to treat compression fractures caused by osteoporosis. Percutaneous vertebroplasty was introduced in the United States in 1994 and has become widely available since 1997 as a treatment for pain associated with compression fractures due to osteoporosis. The procedure has been shown to provide continued pain relief for osteoporotic compression fractures.

Vertebroplasty is an outpatient procedure performed under X-ray-imaging guidance and conscious sedation. The doctor inserts a needle through a nick in the skin of the back, directing it under fluoroscopy (continuous, moving X-ray imaging) into the fractured vertebra. The physician then injects the medical-grade bone cement into the vertebra. The cement hardens within about 15 minutes and stabilizes the fracture.

References

1.Cotten A, Boutry N, Cortet B et al. (1998), Percutaneous vertebroplasty: state of the art. Radiographics 18(2):311-320

2. Deramond H, Depriester C, Galibert P, Le Gars D (1998), Percutaneous vertebroplasty with polymethylmethacrylate. Technique, indications, and results. Radiol Clin North Am 36(3):533-546.

Image: Scanning electron micrograph of bone, showing
Osteoporosis, courtesy Wellcome Images, Creative Commons