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Osteoporotic Compression Fractures: Outcomes after Single- versus Multiple-Level Percutaneous Vertebroplasty¹

¹ From Barnes-Jewish Hospital (A.K.S.) and Washington University School of Medicine (T.K.P., L.A.G.), Mallinckrodt Institute of Radiology, 510 S Kingshighway Blvd, St Louis, MO 63110. Received December 8, 2004; revision requested January 25, 2005; revision received April 8; accepted May 2; final version accepted June 24. Address correspondence to L.A.G. (e-mail: gilulal{at}mir.wustl.edu).

Purpose: To compare single- and multiple-level percutaneous vertebroplasty (PV) in terms of pain relief, activity level, and analgesic use in patients with osteoporotic vertebral compression fractures (VCFs).

Materials and Methods: Institutional review board approval and informed consent were obtained, and the study was HIPAA compliant. One hundred seventy-three patients (mean age at treatment, 73.8 years ± 11.9 [standard deviation]) with 422 symptomatic osteoporotic VCFs underwent 204 treatment sessions for over 4 years. Pain immediately before and after PV was measured by using a visual analogue scale (VAS). Pain degree, activity level, and analgesic use were assessed at 2 weeks and 1, 3, 6, 12, and 24 months after PV by using telephone interview questionnaires. Data were analyzed by using a combination of paired t tests, analysis of variance, contingency tables, and ² tests.

Results: Findings of 172 PV treatment sessions for 149 patients (mean age at treatment, 73.4 years ± 12), 110 (74%) of whom were women, were assessed; 32 treatment cases were lost to follow-up or lost owing to death. A single fracture level was treated at 65 sessions; two fracture levels, at 52 sessions; and three or more fracture levels, at 55 sessions. The mean VAS pain score decreased significantly (P < .001), from 76 ± 21 before to 19 ± 27 immediately after PV. Of the outcomes reported at 24 months, 82% (64 of 78 treatment sessions) were marked to complete resolution of the initial pain, 51% were complete cessation of analgesic use, and 51% were increased activity levels. These results did not differ greatly over time or when stratified into groups according to the number of fracture levels treated.

Conclusion: PV performed at a single fracture level and that performed at multiple fracture levels were equally effective in facilitating long-term pain relief, increased activity level, and decreased analgesic use in patients with osteoporotic VCFs.

© RSNA, 2006

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