Comparative Study of Percutaneous Vertebral Body Perforation and Vertebroplasty for the Treatment of Painful Vertebral Compression Fractures

• Published in: American journal of neuroradiology : AJNR 2012-04, Vol.33 (4), p.685-689
• Main Authors: YOKOYAMA, K, KAWANISHI, M, YAMADA, M, TANAKA, H, ITO, Y, HIRANO, M, KUROIWA, T
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Analgesics; Biological and medical sciences; Bone surgery; Cement; Comorbidity; Compression; Decompression, Surgical - statistics & numerical data; Female; Fractures; Fractures, Compression - epidemiology; Fractures, Compression - therapy; Fundamental and applied biological sciences. Psychology; Human; Humans; Investigative techniques, diagnostic techniques (general aspects); Japan - epidemiology; Leakage; Learning. Memory; Male; Medical sciences; Memory; Middle Aged; Nervous system; Neuroimaging; Pain - epidemiology; Pain - prevention & control; Prevalence; Psychology. Psychoanalysis. Psychiatry; Psychology. Psychophysiology; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Radiography; Risk Assessment; Risk Factors; Spine; Spine - surgery; Surgery; Treatment Outcome; Vertebrae; Vertebroplasty - statistics & numerical data
• ISSN: 0195-6108; 1936-959X
• DOI: 10.3174/ajnr.a2847

Percutaneous vertebral body perforation is a new technique for treating painful VCFs. Herein, we compare the therapeutic effect of vertebral perforation and conventional vertebroplasty for treating VCFs. One hundred eight patients with single painful VCFs were assigned to undergo vertebral perforation (perforation group) or vertebroplasty (PVP group). Clinical outcomes were assessed by using the VAS. The associations of analgesic effect and clinical factors were also analyzed by multivariate regression. Plain radiographs were used to quantify the progression of vertebral body compression after surgery and to evaluate cement leakage and new vertebral fractures. The median follow-up time was 10 months. Baseline characteristics were similar in the 2 groups. No factors correlated with analgesic effects in the PVP group. The analgesic effect of vertebral perforation was, however, related to the preoperative severity of vertebral compression and was low in patients with severe deformity (P < .05). Among patients with preoperative vertebral percentage of compression below 30%, there were no significant differences between the 2 groups in analgesic effect at any postoperative intervals. Progression of vertebral compression after surgery occurred in 22.2% and 16.0% of treated vertebrae in the perforation and PVP groups, respectively (P = .38). Respectively, 3.7% and 20.0% of the perforation and PVP groups had new postoperative fractures during follow-up (P < .05). There were no other complications. Vertebral perforation was safe and effective for painful VCFs with slight compression. However, vertebroplasty should be considered for patients with marked vertebral body compression.