Percutaneous vertebroplasty with bone cement in cases of thoracolumbar vertebral fractures

Shahaydar Shatursunov, Alisher Sattarov, Rustam Musaev, Abduvahob Baboev, Aziz Kobilov

Abstract


Occurrence of vertebral fractures in cases of osteoporosis in Uzbekistan is of 15 % in average. Percutaneous vertebroplasty (PV) is a minimally invasive procedure , which is currently used for the treatment of osteoporotic vertebral fractures (OVF).

Purpose: to evaluate results of vertebroplasty with bone cement in the cases of compression OVF.

Methods: 42 patients (9 male and 33 female, mean age 65 years) with thoracolumbar spine OVF whom PV was performed in 2010-2012. Period of existence of fractures was not less than 3 months. During this period of time conservative treatment was performed. There were none neurological signs in these patients. 30 patients were able to move independently, 10 – with assistance, and 2 were not able to move because of dorsal pain. Localization of lesion was at ThX/LV level. Multiple OVF were in 30 patients. Plan of examination included radiological  absorptiometry, X-ray filming, CT and MRI scanning. Pain was assessed by means of visual analogue scale (VAS), and limitations of movement was assessed by means of Roland-Maurice questionnaire. Vertebroplasty was done by only one surgeon under local anesthesia with 1% of lidocaine under X-ray control. We used polymethylmetakrylat with Karl Storz equipment. PV at one level was in 40 patients (10 dorsal and 30 lumbar vertebrae), at two levels was in 2 ones. After PV we prescribed bed rest allowed to walk on the second day after surgery. Patients were prescribed such osteotropic drugs as alendronate sodium (70 mg 1 time per week), Ca (1000 mg daily) and vitamin D3 (400 MYE per day).

Results: good results of treatment obtained in 30 patients, satisfactory - in 10, and  poor – in 2 ones. After 1 year T-score values increased to 2.7 SD (from -2.3 to 3.5) in average. Before surgery T-score values were -2.9 SD (from -2.9 to -4.0) in average. Average VAS score was 7 (from 6 to 8) before surgery and 3 (from 2 to 4) after surgery. RDQ before surgery was 17.5 (26 to 23) in average, and after one year improved to 12 (from 8 to19) due to pain reduced. In 3 patients penetration of cement into the intervertebral disc, in 1 - into paravertebral tissues, and in 1 – into the spinal canal without any clinical symptoms were revealed.

Conclusion: PV is an effective and safe procedure in cases of OVF but selection of patients is crucial to successful outcome.


Keywords


percutaneous vertebroplasty; osteoporosis; osteoporotic vertebral fractures

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DOI: https://doi.org/10.15674/0030-59872014110-14

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