Multilevel percutaneous vertebroplasty: safety, efficacy and long-term outcomes
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20214961Keywords:
Percutaneous vertebroplasty, Vertebral metastases, Vertebral hemangioma, Osteoporosis, Polymethyl-methacrylateAbstract
Background: The pain in vertebral compression fractures is severe, leading to reduced mobility and quality of life. Percutaneous vertebroplasty is a minimally invasive procedure for treating various spinal pathologies. This study evaluated the usefulness and safety of multilevel PVP (two to three vertebrae) in managing VCF.
Methods: This retrospective study evaluated 59 vertebral levels in 28 patients with VCF who had been operated on for multilevel PVP (two to three levels). There were 22 females and six males, and their ages ranged from 36 to 79 years, with a mean age of 68.95 years. We had injected two levels in 25 patients and three levels in 3 patients. The visual analogue scale was used for pain intensity measurement, and plain X-ray films, computed tomography scan and magnetic resonance imaging was used for radiological assessment. The mean follow-up period was 13.8 months (range, 11-19).
Results: Significant pain improvement was recorded in 26 patients (92.85%). More remarkable improvement in pain was noticed in the immediate postoperative period than in the subsequent follow-ups. Asymptomatic bone cement leakage anteriorly and into the disk spaces in two patients. Isolated anterior leakage has occurred in one patient. There was no encounter of pulmonary embolism.
Conclusions: Multilevel PVP for the treatment of VCF is a safe and effective procedure that can significantly reduce pain and improve patient condition without any significant morbidity. It is considered a cost-effective procedure allowing a rapid restoration of patient mobility.
References
Stallmeyer MJ, Zoarski GH, Obuchowski AM. Optimising patient selection in percutaneous vertebroplasty. J Vasc Interv Radiol. 2003;14:683-96.
Han S, Wan S, Ning L. Percutaneous vertebroplasty versus balloon kyphoplasty for treatment of osteoporotic vertebral compression fracture: a meta-analysis of randomised and non-randomised controlled trials. Int Orthop. 2011;35(9):1349-58.
Jensen ME. Percutaneous vertebroplasty. In: Hurst R, Rosenwasser R, eds. Interventional Neuroradiology. USA: Infroma Healthcare; 2008.
Gangi A, Sabharwal T, Irani FG, Buy X, Morales JP, Adam A. Quality assurance guidelines for percutaneous vertebroplasty. Cardiovasc Intervent Radiol. 2006;29:173-8.
Mailli L, Filippiadis DK, Brountzos EN, Alexopoulou E, Kelekis N, Kelekis A. Clinical outcome and safety of multilevel vertebroplasty: clinical experience and results. Cardiovasc Intervent Radiol. 2013;36:183-91.
Lavanga A, Guarnieri G, Muto M. Medical therapy and multilevel vertebroplasty in osteoporosis: when and why. Neuroradiol J. 2010;23:244-8.
Jones JO, Bruel BM, Vattam SR: Management of painful vertebral hemangiomas with kyphoplasty: a report of two cases and a literature review. Pain Physician. 2009;12:E297-303.
Suparna HC, Vadhiraja BM, Apsani RC. Symptomatic vertebral hemangiomas – results of treatment with radiotherapy. Ind J Radiol Imag. 2006;16:37-40.
Aaron AD. The management of cancer metastatic to bone. JAMA. 1994;272:1206-9.
Coleman RE. Metastatic bone disease: clinical features, pathophy- siology and treatment strategies. Cancer Treat Rev. 2001;27:165-76.
Belkoff SM, Mathis JM, Jasper LE. The biomechanics of vertebroplasty The effect of cement volume on mechanical behavior. Spine. 2001;26(14):1537-41.
Barr JD, Barr MS, Lemley TJ, McCann RM. Percutaneous vertebroplasty for pain relief and spinal stabilization. Spine. 2000;25:923-8.
Zoarski GH, Snow P, Olan WJ, Stallmeyer MJ, Dick BW, Hebel JR, et al. Percutaneous vertebroplasty for osteoporotic compression fractures: quantitative prospective evaluation of long-term outcomes. J Vasc Interv Radiol. 2002;13(1):139-48.
Singh AK, Pilgram TK, Gilula LA. Osteoporotic compression fractures: outcomes after single-versus multiple-level percutaneous vertebroplasty. Radiology. 2006;238:211-20.
Anselmetti GC, Corrao G, Monica PD, Tartaglia V, Manca A, Eminefendic H, et al. Pain relief following percutaneous vertebroplasty: results of a series of 283 consecutive patients treated in a single institution. Cardiovasc Intervent Radiol. 2007;30:441-7.
Kim SH, Kang HS, Choi JA, Ahn JM. Risk factors of new compression fractures in adjacent vertebrae after percutaneous vertebroplasty. Acta Radiol. 2004;45: 440-5.
Uppin AA, Hirsch JA, Centenera LV, Pfiefer BA, Pazianos AG, Choi IS. Occurrence of new vertebral body fracture after percutaneous vertebroplasty in patients with osteoporosis. Radiology. 2003;226:119-24.
Syed MI, Patel NA, Jan S, Harron MS, Morar K, Shaikh A. New symptomatic vertebral compression fractures within a year following vertebroplasty in osteoporotic women. AJNR Am J Neuroradiol. 2005; 26:1601-4.
Spiegl UJ, Beisse R, Hauck S, Grillhösl A, Bühren V. Value of MRI imaging prior to a kyphoplasty for osteoporotic insufficiency fractures. Eur Spine J. 2009;18:1287-92.
Voormolen MH, Lohle PN, Juttmann JR, van der Graaf Y, Fransen H, Lampmann LE. The risk of new osteoporotic vertebral compression fractures in the year after percutaneous vertebroplasty. J Vasc Interv Radiol. 2006;17:71-6.
Trout AT, Kallmes DF, Kaufmann TJ. New fractures after vertebroplasty: adjacent fractures occur significantly sooner. Am J Neuroradiol. 2006;27(1): 217-23.
Liebschner MA, Rosenberg WS, Keaveny TM. Effects of bone cement volume and distribution on vertebral stiffness after vertebroplasty. Spine. 2001; 26(14):1547-54.
Tohmeh AG, Mathis JM, Fenton DC, et al. Biomechanical efficacy of unipedicular versus bipedicular vertebroplasty for the management of osteoporotic compression fractures. Spine. 1999; 24(17):1772-6.
Kaufmann TJ, Trout AT, Kallmes DF. The effects of cement volume on clinical outcomes of percutaneous vertebroplasty. Am J Neuroradiol. 2006;27(9):1933-7.
Heini PF, Wälchli B, Berlemann U. Percutaneous transpedicular vertebroplasty with PMMA: operative technique and early results A prospective study for the treatment of osteoporotic compression fractures. Eur Spine J. 2000;9(5):445-50.
Kim BS, Hum B, Park JC, Choi IS. Retrospective review of procedural parameters and outcomes of percutaneous vertebroplasty in 673 patients. Interv Neuroradiol. 2014;20(5):564-75.
Kim DJ, Kim TW, Park KH. The proper volume and distribution of cement augmentation on percutaneous vertebroplasty. J Korean Neurosurg Soc. 2010;48(2): 125-8.
Chavali R, Resijek R, Knight SK. Extending polymerization time of polymethylmethacrylate cement in percutaneous vertebroplasty with ice bath cooling. Am J Neuroradiol. 2003;24(3):545-6.
Grados F, Depriester C, Cayrolle G, Hardy N, Deramond H, Fardellone P. Long-term observations of vertebral osteoporotic fractures treated by percutaneous vertebroplasty. Rheumatology. 2000;39:1410-4.
McGraw JK, Lippert JA, Minkus KD, Rami PM, Davis TM, Budzik RF. Prospective evaluation of pain relief in 100 patients undergoing percutaneous vertebroplasty: results and follow-up. J Vasc Interv Radiol. 2002;13(1):883-6.
Voormolen MH, Lohle PN, Lampmann LE, van den Wildenberg W, Juttmann JR, Diekerhof CH, et al. Prospective clinical follow-up after percutaneous vertebroplasty in patients with painful osteoporotic vertebral compression fractures. J Vasc Interv Radiol. 2006;17:1313-20.
Guarnieri G, Ambrosanio G, Vassallo P. Vertebroplasty as treatment of aggressive and symptomatic vertebral hemangiomas: up to 4 years of follow-up. Neuroradiology 2009;51:471-6.
Purkayastha S, Gupta AK, KapilamoorthyTR. Percutaneous vertebroplasty in the management of vertebral lesions. Neurol India. 2005;53:167-72.
Yang XJ, Wu ZX, Zhao JF. Treatment of vertebral hemangioma with percutaneous vertebroplasty. J Vasc Interv Radiol. 2004;26:643-6.
Cohen JE, Lylyk P, Ceratto R. Percutaneous vertebroplasty: Technique and results in 192 procedures. Neurol Res. 2004;26:41-9.
Chen L, Zhang CL, Tang TS. Cement vertebroplasty combined with ethanol injection in the treatment of vertebral hemangioma. Chin Med J. 2007;120:1136-9.
Ko YK, Kim YH. Percutaneous vertebroplasty for painful spinal metastasis: a good option for better quality of life. Korean J Anesthesiol. 2013;64(3):201-3.
Pitton MB, Herber S, Koch U, Oberholzer K, Drees P, Düber C. CT-guided vertebroplasty: Analysis of technical results, extraosseous cement leakages, and complications in 500 procedures. Eur Radiol. 2008;18:2568-78.
Martin DJ, Rad AE, Kallmes DF. Prevalence of extravertebral cement leakage after vertebroplasty: Procedural documentation versus CT detection. Acta Radiol. 2012;53:569-72.
Garfin SR, Yuan HA, Reiley MA. New technologies in spine: Kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures. Spine. 2001;26:1511-5.
Lin EP, Ekholm S, Hiwatashi A, Westesson PL. Vertebroplasty: cement leakage into the disc increases the risk of new fracture of adjacent vertebral body. AJNR Am J Neuroradiol. 2004;25:175-80.
Chen HL, Wong CS, Ho ST, Chang FL, Hsu CH, Wu CT. A lethal pulmonary embolism during percutaneous vertebroplasty. Anesth Analg. 2002;95:1060-2.
Jang JS, Lee SH, Jung SK. Pulmonary embolism of polymethylmethacrylate after percutaneous vertebroplasty: a report of three cases. Spine. 2002;27:E416-8.
Benneker LM, Heini PF, Suhm N, Gisep A. The effect of pulsed jet lavage in vertebroplasty on injection forces of polymethylmethacrylate bone cement, material distribution, and potential fat embolism: a cadaver study. Spine. 2008;33:E906-10.
Murphy KJ, Deramond H. Percutaneous vertebroplasty in benign and malignant disease. Neuroimaging Clin N Am. 2000;10:535-45.
Layton KF, Thielen KR, Koch CA, Luetmer PH, Lane JI, Wald JT, et al. Vertebroplasty, first 1000 levels of a single center: evaluation of the outcomes and complications. AJNR Am J Neuroradiol. 2007;28:683-9.
Yu SW, Chen WJ, Lin WC, Chen YJ, Tu YK. Serious pyogenic spondylitis following vertebroplasty-a case report. Spine. 2004;29:E209-11.