Transcript Percutaneous Vertebroplasty in the Osteoporotic Patients

Long-Term Data for 884 Patients Show
Vertebroplasty for Osteoporotic Spinal
Fractures Provides Dramatic Pain
Relief, Greatly Decreases Disability
Giovanni Carlo ANSELMETTI, MD
Institute for Cancer Research and
Treatment Candiolo (TURIN) - Italy
Percutaneous Vertebroplasty
STUDY DESIGN
We prospectively evaluated back-pain
improvement, new fracture rate and
complications in a large series of
Osteoporotic Patients underwent to
Percutaneous Vertebroplasty for
vertebral fracture refractory to
conservative medical treatment
Patients Populations
884 Patients
(750 female - 134 male mean age 73,1 years)
639 Primary Osteoporosis (72,3%)
245 Secondary to Steroidal therapy (27,7%)
Treated on 3954 Vertebrae
All procedures in Local anesthesia
Patients discharged from the Hospital the same
procedural day
Clinical
Evaluation
Pain was evaluated using a 11-point Visual Analogic
Scale from 0 (no pain) to 10 (worst experienced pain)
before and after the procedure.
Disability improvement was evaluated by external
Brace support and Oswestry Disability Questionnaire
before and after Vertebroplasty
If patients reported back-pain recurrence during followup clinical interview and MRI were performed to
investigate new vertebral fracture
Visual Analog Scale Pre e Post VTP
884 patients
Follow-up up to 52 months
SD±1,5
P<0.0001
Wilcoxon signed rank Test
SD±1,8
845/884 patients (95,6%) reported backpain
improvement
Quality of Life after PV
Brace support
Follow-up up to 52 months
P<0.0001
McNemar’s Test
Quality of Life
Oswestry Disability Questionnaire
884 Pts
P<0.0001
Paired t test
SD ±13,5%
SD±6,9%
New Fractures in Osteoporosis
884 Patients - Follow-up up to 52 months
During follow-up all patients were invited to contact us whenever
backpain occurred again after PV.
MR and plain radiograms showed a new vertebral fractures in:
106 patients (12%)
Occurred 15 days to 36 months (mean 9,4±8,7 months) after previous
Vertebroplasty
They were all successfully retreated!
New Fractures in Osteoporosis
Fracture on Contiguous vertebra
73/106 patients (68,9%)
Pts Retreated
Fract. on Contiguous vertebra
%
Binomial exact Test
Two-tail
106
73
68,9
P<0,001
Highly significant
RETREATMENTS in Osteoporosis
New Fracture during 18 months Follow-up
Vertebroplasty vs. Placebo & Teriparatide
Osteoporotic Pts with 1 or more
vertebral collapses at baseline
Vertebroplasty
Personal Series
New Fracture
During 18 months
%
Chi-square
547
75
13,7
P=0.04
Placebo
Lindsay et al. Arch Intern Med 2004; 164:2024-
353
67
18,9
2030.
Signifcant
difference!
20µG Teriparatide
P=0.3
Lindsay et al. Arch Intern Med 2004; 164:20242030.
40µG Teriparatide
Lindsay et al. Arch Intern Med 2004; 164:20242030.
373
42
11,2
345
36
10,4
No difference!
P=0.18
No difference!
COMPLICATIONS
18/884 patients (2%)
Vertebroplasty was completed in all
patients without any major
complications
 12 (1,4%) asymptomatic pulmonary embolism
 6 (0,7%) nerve root irritation successfully treated
by local steroidal injection
CONCLUSIONS
Vertebroplasty is safe and effective in the
treatment of back-pain due to osteoporotic
vertebral collapses.
After Vertebroplasty patients can increase
mobility and improve their quality of life.
New fracture rate seems to be similar to not PVtreated osteoporotic pts reported by literature.
Our data suggest that Vertebroplasty should
always be proposed to patients when conservative
medical treatment fails.