Percutaneous vertebroplasty with bone cement in cases of thoracolumbar vertebral fractures

Authors

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

DOI:

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

Keywords:

percutaneous vertebroplasty, osteoporosis, osteoporotic vertebral fractures

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.

References

Percutaneous vertebroplasty in the treatment of vertebral fractures osteoporotic / G. M. Kavalersky, A. D. Censky, S. K. Makirov [et al.] // Medical Assistance. — 2006. — № 5. — C. 6-9.

A review of vertebroplasty for osteoporotic and malignant vertebral compression fractures [Electronic resource] / A. Montagu, A. Speirs, J. Baldock [et al.] // Mode of access: http://ageing.oxfordjournals.org.

Morozov A. K. Study of strength characteristics of the vertebral bodies before and after percutaneous vertebroplasty in the experiment / A. K. Morozov, E. C. Ogarev, N. C. Gavrushenko // Bulletin of traumatology and orthopedics named. N. N. Priorov. — 2006. — № 4. — C. 59-63.

Astapenko D. C. Complex treatment of patients with osteoporosis, complicated pathological fractures of the vertebral bodies / A. S. Ostapenko // Bulletin of traumatology and orthopedics named. N. N. Priorov. — 2010. — № 3. — C. 43-47.

Vertebroplasty: benefits are more than risks in selected and evidence-based informed patients. A retrospective study of 59 cases / G. B. Brodano, L. Amendola, K. Martikos [et al.] // Eur. Spine. J. — 2011. — Vol. 20. — Р. 1265–1271.

The value of dynamic radiographs in diagnosing painful vertebrae in osteoporotic compression fractures / Y. J. Chen, D. F. Lo, C. H .Chang [et al.] // Am. J. Neuroradiol. — 2011. — Vol. 32. — Р. 121–124.

Long-term results and radiographic fi ndings of percutaneous vertebroplasties with polymethylmethacrylate for vertebral osteoporotic fractures / X. U. Bao-shan, H. U. Yong-cheng, YANG Qiang [et al.] // Chinese Medical Journal. — 2012. — Vol. 125 (16). — Р. 2832–2836.

Comparative study of percutaneous vertebral body perforation and vertebroplasty for the treatment of painful vertebral compression fractures / K. Yokoyama, M. Kawanishi, M. Yamada [et al.] // Am. J. Neuroradiol. — 2012. — Vol. 33.— Р. 685–689.

Role of the spine lateral radiograph of the spine in vertebroplasty for osteoporotic vertebral compression fracture: a prospective study / M. H. Wu, T. J. Huang, Ch. Ch. Cheng [et al.] // BMC Musculoskeletal Disorders. — 2010. — Vol. 11. — Режим доступа: http://www.biomedcentral.com/1471-2474/11/164.

Signifi cance of dynamic mobility in restoring vertebral body height in vertebroplasty / Y. J. Chen, H. Y. Chen, P. P. Tsai [et al.] // Am. J. Neuroradiol. — 2012. — Vol. 33. — Р. 57–60.

Postprocedural CT for perivertebral cement leakage in percutaneous vertebroplasty is not necessary-results from VERTOS II / А. Venmans, C. A. Klazen, W. J. Rooij [et al.] // Neuroradiology. — 2011. — Vol. 53. — Р. 19–22.

Natural history of pain in patients with conservatively treated osteoporotic vertebral compression fractures: results from VERTOS II / A. Venmans, C. A. Klazen, P. N. M. Lohle [et al.] // Am. J. Neuroradiol. — 2012. — Vol. 33. — P. 519–521.

Leitman D. Investigation of polymethylmethacrylate pulmonary embolus in a patient ten years following vertebroplasty / D. Leitman, V. Yu, C. Cox // Radiology Case. — 2011. — Vol. 5 (10). — Р. 14–21.

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ORIGINAL ARTICLES