Speaking at the Society of Interventional Radiology’s annual meeting in San Diego in early March, Dr Noburo Tanigawa, Kansai Medical University, Osaka, Japan, said that PVP was effective in relieving the pain associated with osteoporosis-induced vertebral compression fractures over a long term basis.
Other significant findings from this six-year study were that radiological follow-up observation showed that new compression fractures occurred in about one fourth of the patients, and that more than half of the new compression fractures occurred in adjacent vertebral bodies.
Dr Tanigawa’s team set out to evaluate the technical and clinical outcomes of the first 500 consecutively treated osteoporotic compression fractures to demonstrate long-term efficacy and frequency of new compression fracture after PVP.
Materials and methods
The first 500 osteoporotic compression fractures (T6-L5) treated by PVP at the team’s institution were enrolled in this study. Tanigawa said the sites of cement leakage were evaluated by volumetric CT obtained immediately after PVP. Evaluation at each follow-up time point (one day, 1 month, 4 months, 1 year, 2 years, 3 years, 4 years, 5 years after PVP) included pain response by using visual analog score (VAS) and frontal and lateral plain radiographs of the thoracic and lumbar vertebrae, regardless of the symptoms.
Results
There were 203 patients (mean age :72.9 years, range:44-89 years, 167 women, 36 men) treated between December 2002 and March 2008. These 203 patients underwent 272 sessions to treat 500 compression fractures.
The average cement volume injected was 3.3 ml per level. Cement leakage was found in intradiscal leakages in 105 levels (21%), in epidural vein or paravertebral vein in 100 levels (20%), in soft tissue in 22 levels (4.4%), in spinal canal or neural foramen in six levels (1.2%), and in lung in two cases (0.4%).
Clinically significant complications were encountered in only one patient who had a clinically significant cement leakage into the adjacent disk and underwent surgical decompression.
Average VAS score was 7.5 before PVP, 3.0 at 1 day after PVP, 2.4 at 1 month, 1.8 at 4 months, 1.3 at 1 year, 1.5 at 2 years, 1.5 at 3 years, 2.3 at 4 years, and 1.7 at 5 years after PVP.
New compression fracture was confirmed in 78 vertebral bodies in 52 patients (25.6%), affecting 52 adjacent vertebral bodies (66.7%), 25 non-adjacent vertebral bodies (32%) and 1 treated vertebral body (1.3%).
