Large trial boosts vertebroplasty’s worth

A Mayo Clinic study has proved that vertebroplasty can provide enduring relief from the disability and pain produced by spinal compression fractures. The data come from what may be the longest follow-up trial for vertebroplasty featuring the largest population sample ever recorded by a single institution performing the procedure.

Percutaneous vertebroplasty appears to be an effective therapy. The results of ongoing prospective randomized vertebroplasty trials will be important to confirm this retrospective nonrandomized study, said principal investigator Dr. Kennith F. Layton, an interventional neuroradiology fellow in Mayo's radiology department in Rochester, MN, at the 2006 American Society of Neuroradiology meeting in San Diego.

"Significant improvement in pain, disability, pain medication usage, and mobility was observed in our large patient population over both short- and long-term follow-up time points," Layton said.

Layton and colleagues retrospectively reviewed 1000 compression fractures from 552 patients treated with percutaneous polymethylmethacrylate (PMMA) vertebroplasty in 673 sessions. The end points of the study were pain relief, functional improvement, changes in mobility and pain medication usage, and clinically relevant complications.

The investigators found that about 90% of patients reported complete relief or significant decrease of pain two years after treatment. They also found that 78% and up to 80% of patients reported increased mobility and reduced dependency on pain relief medication, respectively, two years after vertebroplasty.

Patient were from 28 to 96 years of age, and 69% were female. Sixty-three percent presented with single-fracture lesions. The number of fractures treated varied from one to five (mean, 1.48) per procedure. Eighty-four percent of lesions related to osteoporosis, while 11% and 5% related to neoplasms and trauma, respectively. Physicians reported most fractures affected the thoracolumbar junction area.

All patients underwent assessment before and two hours after the procedure. A specialized nurse conducted follow-up telephone interviews with patients one week after the procedure and at one, six, and 24 months postprocedure. These interviews evaluated outstanding pain using a 10-point pain scale (at rest and with activity), pain relief, changes in mobility and in pain medication usage, and functional outcomes using the Roland-Morris disability questionnaire.

Researchers found 12 clinically significant complications (1.8%):

• eight rib or vertebral transverse process fractures

• three cement-related complications (two radiculopathies and one cement-induced pulmonary embolus)

• one case of central canal compromise due to a metastatic tumor

The complication rate remains typically low when experienced operators perform vertebroplasty, Layton said.

Layton's paper won the American Society of Spine Radiology Mentor Award at the ASSR 2006 Annual Symposium in February. ASNR officials bestowed the official diploma and a $1000 check at the end of his presentation.

For more information from the Diagnostic Imaging archives:

Vertebroplasty keeps goats kicking

Kyphoplasty, vertebroplasty proponents reach detente

Vertebroplasty spells relief for back pain

Vertebral fracture identification rounds out osteoporosis Dx