Multi-Level Vertebroplasty for 6 or More Painful Osteoporotic Vertebral Body Compression Fractures Performed in the Same Procedural Setting: A Safety and Efficacy Report in Cancer Patients.

Abstract

PURPOSE:

To assess safety and efficacy of multi-level vertebroplasty, when treating 6 or more levels in the same procedural setting for the management of osteoporotic vertebral compression fractures (oVCF) in cancer patients.

MATERIALS AND METHODS:

Single institution retrospective review from 2015 to 2019 of patients treated for multi-level oVCF in a single session procedural setting by vertebroplasty of 6 or more levels. Procedure outcomes collected included procedural complications, pre- and 4 week post-procedure pain score by numeric rating scale, opioid usage, and vertebral height changes.

RESULTS:

In total, 197 vertebral levels were treated in 24 procedures (mean 8.2 ± 1.8 levels). Mean procedure duration was 167 + / - 41 min, and mean postoperative hospitalization duration was 2.1 + / - 1.9 days. Four grade I or II complications occurred according to CIRSE classification. Two patients had a symptomatic pulmonary cement embolism; although there was no statistical difference between pre- and postoperative mean blood saturation (95.9 + / - 1.7% and 94.8 + / - 2.0%, respectively, p = 0.066). Pain score significantly improved after treatment (6.5 ± 1.3 vs 3.2 + / - 1.4, p < 0.0001) with a mean decrease of 3.3 (51%). Post-procedure daily opioid use also significantly improved (mean 35.8 + / - 36.8 mg/24 h vs 18.5 + / - 27.8 mg/24 h, p = 0.0089), with a mean decrease of 17.3 mg/24 h (48%). Refracture was found in 2 of 105 levels treated (1.9%), and no difference was found in thoraco-lumbar height and angulation. Five patients experienced new painful fractures at a non-treated level.

CONCLUSION:

Multi-level vertebroplasty for 6 or more levels is a safe and effective treatment for the management of multi-level oVCF in cancer patients.

• Authors: Benjamin Moulin, Alexandre Delpla, Lambros Tselikas, Marc Al Ahmar, Clara Prud'homme, Charles Roux, Steven Yevich, Sophie Laurent, Antoine Hakime, Christophe Territehau, Guillaume Gravel, Thierry De Baere, Fréderic Deschamps
• Journal: Cardiovascular and interventional radiology (Cardiovasc Intervent Radiol) Vol. 43 Issue 7 Pg. 1041-1048 (Jul 2020) ISSN: 1432-086X [Electronic] United States
• PMID: 32382857 (Publication Type: Journal Article)

Chemical References

• Bone Cements

Topics

• Aged
• Aged, 80 and over
• Bone Cements (therapeutic use)
• Female
• Fractures, Compression (complications, diagnostic imaging, surgery)
• Humans
• Male
• Middle Aged
• Neoplasms (complications)
• Osteoporotic Fractures (complications, diagnostic imaging, surgery)
• Pain (etiology)
• Retrospective Studies
• Tomography, X-Ray Computed (methods)
• Treatment Outcome
• Vertebroplasty (methods)