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Percutaneous vertebroplasty: optimizing the procedure after treatment of 250 vertebral levels under fluoroscopic guidance

Vertebroplastica percutanea: ottimizzazione della procedura dopo trattamento di 250 livelli sotto guida fluoroscopica

  • Musculoskeletal Radiology / Radiologia Muscolo-Scheletrica
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Purpose

Percutaneous vertebroplasty (PVP) is a minimally invasive treatment for symptomatic vertebral compression fractures (VCFs). The aim of this study was to assess the effectiveness, complications and progress of results of PVP optimized in terms of technique, costs, time and strategic protocol after 3 years of procedures performed under fluoroscopic guidance alone.

Materials and methods

We treated 250 VCFs in 120 consecutive patients after assessing clinical and radiological indications. The effectiveness of the procedure was determined by statistical analysis of numerical scores for pain, mobility and drug consumption before and after treatment.

Results

No major complications and only three minor complications occurred. Clinically relevant improved mobility and reduction of pain and analgesics were observed, with overall significant results (p<0.0001) in all patients at 24 h after PVP and in 83 available patients at 6 months. A total of five asymptomatic refractures of cemented vertebrae and 14 new symptomatic vertebral fractures at different levels were observed between 1 and 10 months after the procedure.

Conclusions

PVP is a safe, rapid, effective and costeffective therapy for VCFs, requiring only brief hospital admission and with long-lasting clinical results, when performed under good-quality radiological guidance, when correct indications are respected and when it is associated with rehabilitation therapy in the follow-up. It is a valid alternative to conservative therapy, which is burdened by high healthcare costs and often requires long-term immobilisation of frail and elderly patients at risk of clinical complications.

Riassunto

Obiettivo

La vertebroplastica percutanea (VPP) è un trattamento mininvasivo per le fratture vertebrali sintomatiche da compressione (FVC). Scopo del presente lavoro è quello di valutare l’efficacia, le complicanze e la progressione dei risultati della VPP ottimizzata in termini di tecnica, costi, tempi e protocollo strategico dopo 3 anni di procedure effettuate sotto esclusiva guida fluoroscopica.

Materiali e metodi

Sono state trattate 250 FVC in 120 pazienti consecutivi dopo valutazione delle indicazioni cliniche e radiologiche. L’efficacia della procedura è stata determinata attraverso l’analisi statistica di score numerici per il dolore, la mobilità e l’uso di farmaci antalgici prima e dopo il trattamento.

Risultati

Non si sono verificate complicanze maggiori e solo 3 complicanze minori. È stato osservato un miglioramento della mobilità e riduzione del dolore e dell’uso di farmaci antalgici clinicamente rilevanti con risultati significativi (p<0,0001) in tutti i pazienti a 24 ore dalla VPP e, in 83 pazienti reperibili, a distanza di 6 mesi. Sono stati rilevati 5 nuovi cedimenti asintomatici in vertebre precedentemente trattate e 14 nuove fratture sintomatiche su livelli differenti da 1 a 10 mesi dopo la procedura.

Conclusioni

La VPP costituisce un trattamento sicuro, rapido, efficace, poco costoso, che richiede solo un ricovero breve e con risultati clinici duraturi qualora sia impiegato un sistema di guida radiologica di buona qualità, siano rispettate le corrette indicazioni e venga associata una terapia riabilitativa nel follow-up. Rappresenta una valida alternativa alla terapia conservativa, quest’ultima gravata da elevati costi sanitari e che richiede spesso l’immobilizzazione prolungata di pazienti fragili e anziani, a rischio di complicanze cliniche.

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Authors and Affiliations

  1. Dipartimento di Bioimmagini e Scienze Radiologiche, Università Cattolica del Sacro Cuore, Policlinico A. Gemelli, L.go Gemelli 1, 00168, Rome, Italy

    A. Pedicelli, M. Rollo, M. Piano, G. Grattacaso, C. Colosimo & L. Bonomo

  2. Via Trionfale 7130, 00135, Rome, Italy

    A. Pedicelli

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  1. A. Pedicelli
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  2. M. Rollo
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  3. M. Piano
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  4. G. Grattacaso
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  5. C. Colosimo
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  6. L. Bonomo
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Correspondence to A. Pedicelli.

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Pedicelli, A., Rollo, M., Piano, M. et al. Percutaneous vertebroplasty: optimizing the procedure after treatment of 250 vertebral levels under fluoroscopic guidance. Radiol med 114, 1141–1158 (2009). https://doi.org/10.1007/s11547-009-0448-9

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  • DOI: https://doi.org/10.1007/s11547-009-0448-9

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