Abstract No. 16: Percutaneous Vertebroplasty (PV) in the Osteporotic Patients: Optimal Indications and Patient Selection to Improve Clinical Outcome. Personal Experience in 1542 Patients over 7 Years Experience

PurposePatients (pts) selection, optimal indications and post-procedural management to achieve the best clinical outcome.Materials and MethodsSince 2002, 2251 osteoporotic pts (1811 female, mean age 65.4±10.7 yrs), suffering from back-pain for vertebral collapses, underwent clinical interview in our Institute. All pts had 1 or more vertebral collapses at Magnetic Resonance (MRI); clinical palpation of fractured vertebrae evocated pain in 1860 (82.6%), among these, 842 (45.3%) had pain duration <1 month whereas the remnant had pain from 1 to 23 months. Only 661/2251 (29.4%) had previous medical treatment for osteoporosis by a qualified rheumatologist. After optimal medical treatment was applied, (from 1.5 to 3 months), 709/2251 (31.5%) reported back-pain regression and scheduled PV was not performed. 1542 pts (1302 female, mean age 73.5±9.8 yrs), not improved by medical therapy and with collapsed vertebrae at MRI (1204 with bone marrow edema), underwent to PV. After PV, medical therapy for osteoporosis was continued in all pts by rheumatologist. Prospective clinical follow-up evaluated Visual Analog Scale (VAS) and Oswestry Disability Questionnaire (ODQ) at 15 days, 1, 3, 6, 12, 18 and every 6 months.ResultsIn 1494 pts (96.9%) VAS and ODQ significantly changed from 8.2±1.8 to 1.1±1.6 (p<.0005 Wicoxon test) and from 68.7±7.6% to 18.5±8.2% (p<.0005 t-test) respectively (early follow-up -3 months). Long-term follow-up (72-18 months, mean 31.2±13.3) was performed in 1017 pts (857 female, mean age 72±10.3 yrs): mean VAS of 7.9±1.5 significantly dropped to 1.3±1.7; among 757 pts wearing the brace before PV, 683 could avoid it after PV (χ2=680.01, p<.0001). In 124 (12.2%) a new painful vertebral fracture occured during follow-up.ConclusionDespite recently published trial (1Kallmes D.F. et al.A randomized trial of vertebroplasty for osteoporotic spinal fractures.N Engl J Med. 2009; 361: 569-579Crossref PubMed Scopus (1086) Google Scholar), in our experience PV is effective in treatment of chronic back-pain due to osteoporotic vertebral collapses undermanaged by optimal medical therapy lasting from 1 to 3 months. To achieve the best clinical outcome, optimal pts selection, correct indications and optimal medical treatment of osteoporosis are mandatory. PurposePatients (pts) selection, optimal indications and post-procedural management to achieve the best clinical outcome. Patients (pts) selection, optimal indications and post-procedural management to achieve the best clinical outcome. Materials and MethodsSince 2002, 2251 osteoporotic pts (1811 female, mean age 65.4±10.7 yrs), suffering from back-pain for vertebral collapses, underwent clinical interview in our Institute. All pts had 1 or more vertebral collapses at Magnetic Resonance (MRI); clinical palpation of fractured vertebrae evocated pain in 1860 (82.6%), among these, 842 (45.3%) had pain duration <1 month whereas the remnant had pain from 1 to 23 months. Only 661/2251 (29.4%) had previous medical treatment for osteoporosis by a qualified rheumatologist. After optimal medical treatment was applied, (from 1.5 to 3 months), 709/2251 (31.5%) reported back-pain regression and scheduled PV was not performed. 1542 pts (1302 female, mean age 73.5±9.8 yrs), not improved by medical therapy and with collapsed vertebrae at MRI (1204 with bone marrow edema), underwent to PV. After PV, medical therapy for osteoporosis was continued in all pts by rheumatologist. Prospective clinical follow-up evaluated Visual Analog Scale (VAS) and Oswestry Disability Questionnaire (ODQ) at 15 days, 1, 3, 6, 12, 18 and every 6 months. Since 2002, 2251 osteoporotic pts (1811 female, mean age 65.4±10.7 yrs), suffering from back-pain for vertebral collapses, underwent clinical interview in our Institute. All pts had 1 or more vertebral collapses at Magnetic Resonance (MRI); clinical palpation of fractured vertebrae evocated pain in 1860 (82.6%), among these, 842 (45.3%) had pain duration <1 month whereas the remnant had pain from 1 to 23 months. Only 661/2251 (29.4%) had previous medical treatment for osteoporosis by a qualified rheumatologist. After optimal medical treatment was applied, (from 1.5 to 3 months), 709/2251 (31.5%) reported back-pain regression and scheduled PV was not performed. 1542 pts (1302 female, mean age 73.5±9.8 yrs), not improved by medical therapy and with collapsed vertebrae at MRI (1204 with bone marrow edema), underwent to PV. After PV, medical therapy for osteoporosis was continued in all pts by rheumatologist. Prospective clinical follow-up evaluated Visual Analog Scale (VAS) and Oswestry Disability Questionnaire (ODQ) at 15 days, 1, 3, 6, 12, 18 and every 6 months. ResultsIn 1494 pts (96.9%) VAS and ODQ significantly changed from 8.2±1.8 to 1.1±1.6 (p<.0005 Wicoxon test) and from 68.7±7.6% to 18.5±8.2% (p<.0005 t-test) respectively (early follow-up -3 months). Long-term follow-up (72-18 months, mean 31.2±13.3) was performed in 1017 pts (857 female, mean age 72±10.3 yrs): mean VAS of 7.9±1.5 significantly dropped to 1.3±1.7; among 757 pts wearing the brace before PV, 683 could avoid it after PV (χ2=680.01, p<.0001). In 124 (12.2%) a new painful vertebral fracture occured during follow-up. In 1494 pts (96.9%) VAS and ODQ significantly changed from 8.2±1.8 to 1.1±1.6 (p<.0005 Wicoxon test) and from 68.7±7.6% to 18.5±8.2% (p<.0005 t-test) respectively (early follow-up -3 months). Long-term follow-up (72-18 months, mean 31.2±13.3) was performed in 1017 pts (857 female, mean age 72±10.3 yrs): mean VAS of 7.9±1.5 significantly dropped to 1.3±1.7; among 757 pts wearing the brace before PV, 683 could avoid it after PV (χ2=680.01, p<.0001). In 124 (12.2%) a new painful vertebral fracture occured during follow-up. ConclusionDespite recently published trial (1Kallmes D.F. et al.A randomized trial of vertebroplasty for osteoporotic spinal fractures.N Engl J Med. 2009; 361: 569-579Crossref PubMed Scopus (1086) Google Scholar), in our experience PV is effective in treatment of chronic back-pain due to osteoporotic vertebral collapses undermanaged by optimal medical therapy lasting from 1 to 3 months. To achieve the best clinical outcome, optimal pts selection, correct indications and optimal medical treatment of osteoporosis are mandatory. Despite recently published trial (1Kallmes D.F. et al.A randomized trial of vertebroplasty for osteoporotic spinal fractures.N Engl J Med. 2009; 361: 569-579Crossref PubMed Scopus (1086) Google Scholar), in our experience PV is effective in treatment of chronic back-pain due to osteoporotic vertebral collapses undermanaged by optimal medical therapy lasting from 1 to 3 months. To achieve the best clinical outcome, optimal pts selection, correct indications and optimal medical treatment of osteoporosis are mandatory.