Abstract | PURPOSE: MATERIALS AND METHODS: Patients with intractable pain from vertebral metastases (many resistant to palliative radiation therapy) and patients with intractable painful osteoporotic fractures were treated with parapedicular or transpedicular injection of PMMA. Plane X-rays, computed tomography (CT) scan, and magnetic resonance imaging (MRI) scan were performed on all patients. With a reflex hammer, percussion pain was correlated to the imaging abnormalities. The preplanning CT scan was used to calculate the exact entry point and angle of the bone-biopsy needle. All patients were assessed before and after the procedure for quality of life and amount of pain. The following measures were used: 1) the Edmonton Symptom Assessment System (ESAS), for global pain, nausea, tiredness, depression, anxiety, drowsiness, appetite, sense of well-being, and shortness of breath; 2) a site-specific pain score (SSPS); 3) the amount of analgesic intake in morphine equivalents in the last 24 hours; and 4) the Townsend Functional Assessment Scale (TFAS), ascertaining mobility. A postprocedural CT scan was performed the same day on all patients. Follow-up assessment consisted of a phone call at Days 1, 2, and 4 and Weeks 1, 2, 4, 8, and 12. Patients with recurrent back pain or complications were followed in the bone metastases clinic. RESULTS: Thirty patients (19 women, 11 men) were evaluated. Their median age was 68 years (range 31 to 87 years). Thirty procedures ( n = 30) at 45 vertebral levels were performed; 13 were for pathologic fractures, and 17 were for osteoporotic fractures. SSPS showed a decrease of 2 or more levels in 88.5% of patients at 12-week follow-up. The mean SSPS with movement was 8.7 preprocedure and 1.8 postprocedure (P < 0.0001). Also, there was significant improvement in all 9 ESAS domains (P < 0.0004). The ingestion of analgesics in morphine equivalents showed a trend toward reduction post-PVP (P < 0.0599). When the patients with pathologic fractures were separated out, the reduction in ingestion of analgesics was significant (P < 0.0008). The TFAS demonstrated significant improvement in patient mobility and function. Extravertebral extravasation of cement was noted in 55.6% of the levels. We used a general linear mixed-model repeated-measures analysis of variance to analyze the data. CONCLUSIONS: PVP in osteoporotic and metastatic fractures significantly improved many patients' global quality-of-life scores and function by markedly decreasing their back pain and reducing their intake of pain medications. The procedure is safe, with no serious complications noted in our study.
|
Authors | Gordon Cheung, Edward Chow, Lori Holden, Marjan Vidmar, Cyril Danjoux, Albert J M Yee, Ruth Connolly, Joel Finkelstein |
Journal | Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes
(Can Assoc Radiol J)
Vol. 57
Issue 1
Pg. 13-21
(Feb 2006)
ISSN: 0846-5371 [Print] United States |
PMID | 16719207
(Publication Type: Comparative Study, Evaluation Study, Journal Article)
|
Chemical References |
- Bone Cements
- Polymethyl Methacrylate
|
Topics |
- Adult
- Aged
- Aged, 80 and over
- Biopsy, Needle
- Bone Cements
(therapeutic use)
- Data Interpretation, Statistical
- Female
- Follow-Up Studies
- Fractures, Spontaneous
(etiology)
- Humans
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Orthopedic Procedures
- Osteoporosis
(complications)
- Pain Measurement
- Pain, Intractable
(etiology, therapy)
- Polymethyl Methacrylate
(administration & dosage)
- Prospective Studies
- Quality of Life
- Safety
- Spinal Fractures
(diagnosis, diagnostic imaging, etiology, pathology, surgery)
- Spinal Fusion
- Spinal Neoplasms
(complications, secondary)
- Spine
(pathology)
- Time Factors
- Tomography, X-Ray Computed
- Treatment Outcome
|