Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fracture

Abstract

Objective: To assess the safety and efficacy of percutaneous vertebroplasty in the treatment of single level Osteo-porotic Vertebral Compression Fractures (OVCF). Study Design: This was a case series study. Place and Duration of Study: Department of Neurosurgery Unit I, Lahore General Hospital, Lahore from Jan-uary 2012 to January 2014.
Methodology: All 57 patients received PVP in the current study. Feasibility of a unilateral approach was judged before surgery using the 64 – slice helical computed tomography (CT) multiplanar reconstruction technique, a 3D accurate puncture plan was then determined. The skin bone distance, puncture angle and needle insertion depth were recorded during surgery. 2D CT rechecking was performed for any complication at day 1 after operation. Preoperative and postoperative numerical data were compared patients fulfilling the inclusion criteria were given time in the out – patient department for vertebroplasty. Patients who had a neoplastic etiology (meta-stasis or myeloma), infection, neural compression, traumatic fracture, neurological deficit, spinal stenosis, severe degenerative diseases of the spine or previous surgery at the involved vertebral body were excluded from our study. Prior to vertebroplasty the patient’s level of pain was recorded by using the visual analogue scale method: a scale of 0 – 10, with 10 indicating the most pain. After vertebroplasty, patients were asked whether their pain was completely relieved, partially relieved, unchanged, or worse. The post vertebroplasty visual analogue scale score were recorded on the day of vertebroplasty immediately after the end of the procedure and at 24 hours and then at the follow up visits at 2 weeks, 1 month, 3 months, 6 months, and 1 year intervals.
Results: In this study there were 20 (35.1%) male and 37 (64.9%) female patients. The mean age of patients was 59.12 ± 12.40 years with minimum and maximum age 39-88 years respectively. On pre procedure assessment, fractures of L1, L2 and L3 were seen in 10 (17.5%), 6 (10.5%) and 5 (8.8%) respectively while T11 and T12 were seen in 6 (10.5%) and 16 (28.15%) respectively. Mean pre and postoperative pain on VAS was 7.91 ± 1.17 and 1.17 ± 1.45. After surgery mean difference in pain score was 6.73 ± 1.90 with fulfillment of normality assumptions (Kolmogorov-Smirnov Z = 1.18, p-value = 0.123). On applying paired sample t-test significant improvement in pain was found after surgery, t=26.71, p-value < 0.001. Mean cement volume and vertebral collapse was 6.42 ± 1.60 and 29.29 ± 4.19 respectively.
Conclusion: Vertebroplasty is safe and effective procedure for osteoporotic vertebral collapse and its a day care procedure and can be performed safely under local anaesthesia.