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01-02-2008 | Interventional Neuroradiology

Pain reduction in osteoporotic patients with vertebral pain without measurable compression

Authors: Xinjian Yang, Shijun Mi, Ankit A. Mahadevia, Xin Lin, Wanchao Shi, Aihua Liu, Li Li, Zhongxue Wu, Kieran Murphy

Published in: Neuroradiology | Issue 2/2008

Abstract

Introduction

Non-compression osteoporotic vertebral pain (NCOVP) can also cause pain and severe immobilization, such as typical vertebral compression fracture (VCF). The aim of this study was to evaluate whether patients with NCOVP refractory to medical treatment and severely affecting normal daily activities could be offered therapeutic benefit with percutaneous vertebroplasty.

Methods

We conducted a retrospective review of the records of consecutive percutaneous vertebroplasty procedures performed at our institutions during a 28-month period to define a population of patients who suffered from severe NCOVP. Nine such patients were identified based on physical examination, computed tomography, magnetic resonance (MR) imaging, and bone scans. Initial clinical outcomes were assessed by comparing quantitative measurements of pain (10-point scale) and mobility (5-point scale) 1 day before the operation with those 1 day post-operation. A second follow-up took place between 2 weeks and 1 month after the operation, with a third follow-up between 6 and 10 months post-operative. Biopsy was taken in each case.

Results

Each patient demonstrated point tenderness over radiographically normal-shaped vertebra. Every patient showed a low signal on T1W images, and seven cases showed a high signal on T2W images inside the vertebra, indicating bone marrow edema. All patients experienced a reduction in pain and an increase in mobility after percutaneous vertebroplasty, with a mean pain reduction of 7.0 points and an average improved mobility of 2.8 points. Biopsy results indicated necrotic and/or degenerative changes in eight cases.

Conclusion

The clinical outcomes of our patients suggest that NCOVP, mainly verified by abnormal MR signals and biopsy results, can be successfully treated by percutaneous vertebroplasty.

Deramond H, Depriester C, Galibert P, Le Gars D (1998) Percutaneous vertebroplasty with polymethylmethacrylate: technique, indications, and results. Radiol Clin North Am 36:533–546PubMedCrossRef

Murphy KJ, Deramond H (2000) Percutaneous vertebroplasty in benign and malignant disease. Neuroimaging Clin N Am 10:535–545PubMed

Mathis JM, Barr JD, Belkoff SM, Barr MS, Jensen ME, Deramond H (2001) Percutaneous vertebroplasty: a developing standard of care for vertebral compression fractures. Am J Neuroradiol 22:373–381

Diamond TH, Champion B, Clark WA (2003) Management of acute osteoporotic vertebral fractures: a nonrandomized trial comparing percutaneous vertebroplasty with conservative therapy. Am J Med 114:257–265PubMedCrossRef

Alvarez L, Perez-Higueras A, Quinones D, Calvo E, Rossi RE (2003) Vertebroplasty in the treatment of vertebral tumors: postprocedural outcome and quality of life. Eur Spine J 22:1–3

Gangi A, Guth S, Imbert JP, Marin H, Dietemann JL (2003) Percutaneous vertebroplasty: indications, technique, and results. Radiographics 23:10–14CrossRef

Hodler J, Peck D, Gilula LA (2003) Midterm outcome after vertebroplasty: predictive value of technical and patient-related factors. Radiology 227:662–668PubMedCrossRef

Grados F, Depriester C, Cayrolle G, Hardy N, Deramond H, Fardellone P (2000) Long-term observations of vertebral osteoporotic fractures treated by percutaneous vertebroplasty. Rheumatology (Oxford) 39:1410–1414CrossRef

Gaughen JR Jr, Jensen ME, Schweickert PA, Marx WF, Kallmes DF (2002) The therapeutic benefit of repeat percutaneous vertebroplasty at previously treated vertebral levels. Am J Neuroradiol 23:1657–1661PubMed

10.

Uppin AA, Hirsch JA, Centenera LV, Pfiefer BA, Pazianos AG, Sup Choi In (2003) Occurrence of new vertebral body fracture after percutaneous vertebroplasty in patients with osteoporosis. Radiology 226:119–124PubMedCrossRef

11.

Yang X, Murphy KJ (eds) (2004) Percutaneous vertebroplasty. People’s Medical Publishing House, Beijing

12.

Yang X, Wu Z, Zhao J, Zhang Y, Song L, He H, Lin X (2004) Treatment of vertebral hemangioma with percutaneous vertebroplasty. Acta Acad Med Sin 26:643–647

13.

Yang X, Wu Z, Lin X, Zhang Y, Liu A, Shi W (2005) Treatment of senior and severe vertebral compressive fractures with percutaneous vertebroplasty. Acta Acad Med Sin 27:38–41

14.

Martin JB, Jean B, Sugiu K, San Millan Ruiz D, Piotin M, Murphy K, Rufenacht B, Muster M, Rufenacht DA (1999) Vertebroplasty: clinical experience and follow-up results. Bone 25[Suppl]:11S–15SPubMedCrossRef

15.

Mathis JM, Barr JD, Belkoff SM, Barr MS, Jensen ME, Deramond H (2001) Percutaneous vertebroplasty: a developing standard of care for vertebral compression fractures. Am J Neuroradiol 22:373–381PubMed

16.

Baur A, Stäbler A, Arbogast S, Duerr HR, Bartl R, Reiser M (2002) Acute osteoporotic and neoplastic vertebral compression fractures: fluid sign at MR imaging. Radiology 225:730–735PubMedCrossRef

17.

Yuh WT, Mayr NA, Petropoulou K, Beall DP (2003) Fluid sign in osteoporotic vertebral fracture. Radiology 227:905PubMedCrossRef

18.

Baker LL, Goodman SB, Perkash I, Lane B, Enzmann DR (1990) Benign versus pathologic compression fractures of vertebral bodies: assessment with conventional spin-echo, chemical shift, and STIR MR imaging. Radiology 174:495–502PubMed

19.

Finelli DA (2001) Diffusion-weighted imaging of acute vertebral compressions: specific diagnosis of benign versus malignant pathologic fractures. Am J Neuroradiol 22:241–242PubMed

20.

Baur A, Huber A, Ertl-Wagner B, Durr R, Zysk S, Arbogast S, Deimling M, Reiser M (2001) Diagnostic value of increased diffusion weighting of a steady-state free precession sequence for differentiating acute benign osteoporotic fractures from pathologic vertebral compression fractures. Am J Neuroradiol 22:366–372PubMed

21.

Maynard AS, Jensen ME, Schweickert PA, Marx WF, Short JG, Kallmes DF (2000) Value of bone scan imaging in predicting pain relief from percutaneous vertebroplasty in osteoporotic vertebral fractures. Am J Neuroradiol 21:1807–1812PubMed

22.

Gaughen JR, Jensen ME, Schweickert PA, Marx WF, Kallmes DF (2002) The therapeutic benefit of repeat percutaneous vertebroplasty at previously treated vertebral levels. Am J Neuroradiol 23:1657–1661PubMed

Title: Pain reduction in osteoporotic patients with vertebral pain without measurable compression
Authors: Xinjian Yang
Shijun Mi
Ankit A. Mahadevia
Xin Lin
Wanchao Shi
Aihua Liu
Li Li
Zhongxue Wu
Kieran Murphy
Publication date: 01-02-2008
Publisher: Springer-Verlag
Published in: Neuroradiology / Issue 2/2008
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI: https://doi.org/10.1007/s00234-007-0311-4

At a glance: The STEP trials

Springer Medicine

Pain reduction in osteoporotic patients with vertebral pain without measurable compression

Abstract

Introduction

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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