Validity of Intervertebral Bone Cement Infusion for Painful Vertebral Compression Fractures Based on the Presence of Vertebral Mobility

Vertebroplasty using bone cement is well known to provide marked relief of prolonged pain from vertebral compression fractures (VCFs) and to improve activities of daily living for patients. We have treated patients with painful VCFs using vertebroplasty for more than 10 years. However, at this time, some clinicians claim that analgesic effects obtained by vertebroplasty are placebo effects. Some recent randomized studies have failed to evaluate the efficacy of cement infusion. Vertebroplasty for VCF was a procedure originally expected to exert analgesic effects via injection of bone cement into vertebral bodies destabilized by pseudoarthrosis in an attempt to stabilize them. Unfortunately, the presence or absence of pseudoarthrosis was not considered in recent reports of randomized studies. Our study aimed to assess the validity of cement infusion performed for pain relief based on the presence or absence of pseudoarthrosis. We compared therapeutic effects between vertebroplasty and vertebral perforation without bone cement infusion in patients with painful VCF. We found that intervertebral bone cement infusion apparently contributes to pain relief in patients with painful VCF with vertebral mobility. On the other hand, it is not certain whether intervertebral bone cement infusion in patients with fractures and lacking vertebral mobility is effective. We think that the presence of the vertebral mobility is the most important factor in the application of vertebroplasty.

References

1. Yokoyama K, Kawanishi M, Yamada M, et al. Comparative Study of Percutaneous Vertebral Body Perforation and Vertebroplasty for the Treatment of Painful Vertebral Compression Fractures. AJNR Am J Neuroradiol 2012;33:685-89. doi: doi: 10.3174/ajnr.A2847
2. Yokoyama K, Kawanishi M, Yamada M, et al. In Not Only Vertebroplasty but Also Kyphoplasty, the Resolution of Vertebral Deformities Depends on Vertebral Mobility. AJNR Am J Neuroradiol 2013 Feb 7 [Epub ahead of print]. doi: 10.3174/ajnr.A3424
3. Yokoyama K, Kawanishi M, Yamada M, et al. Safety and therapeutic efficacy of the second treatment for new fractures developed after initial vertebroplasty performed for painful vertebral compression fractures. Neurol Res 2013 Feb 13 [Epub ahead of print]

In Not Only Vertebroplasty but Also Kyphoplasty, the Resolution of Vertebral Deformities Depends on Vertebral Mobility

In patients treated by percutaneous vertebroplasty, dynamic fracture mobility is well known to greatly affect the vertebral height restoration and kyphotic changes after bone cement injection. In order to examine whether inflation of a balloon might actually contribute to the vertebral height restoration or kyphotic changes in balloon kyphoplasty, comparison with percutaneous vertebroplasty should be made after adjustment for dynamic fracture mobility. We determined the presence or absence of vertebral mobility in patients with vertebral compression fractures who underwent balloon kyphoplasty or percutaneous vertebroplasty, based on the findings of preoperative dynamic radiographic imaging, and divided the patients into those with and without unstable vertebral bodies. Then, the vertebral height restoration and kyphotic changes were compared between the 2 treatment groups. The results revealed that the vertebral height restoration and kyphotic changes that were achieved after surgery largely depended on the preoperative vertebral mobility in not only the patients treated by percutaneous vertebroplasty but also those treated by balloon kyphoplasty. Our study revealed that the use of the balloon in kyphoplasty contributed little to the resolution of vertebral deformities following surgery. Based on these results, we believe the only advantage that might be expected from balloon kyphoplasty is the lower volume of bone cement that needs to be injected, and thereby lower incidence of leakage from the vertebral body, which is an advantage in terms of safety rather than in the degree of vertebral height restoration or kyphotic changes.

References

1. Yokoyama K, Kawanishi M, Yamada M, et al. Comparative Study of Percutaneous Vertebral Body Perforation and Vertebroplasty for the Treatment of Painful Vertebral Compression Fractures. AJNR Am J Neuroradiol 2012;33:685-89. doi: 10.3174/ajnr.A2847
2. Yokoyama K, Kawanishi M, Yamada M, et al. Validity of Intervertebral Bone Cement Infusion for Painful Vertebral Compression Fractures Based on the Presence of Vertebral Mobility. AJNR Am J Neuroradiol 2013;34:228-32. doi: 10.3174/ajnr.A3160
3. Yokoyama K, Kawanishi M, Yamada M, et al. Safety and therapeutic efficacy of the second treatment for new fractures developed after initial vertebroplasty performed for painful vertebral compression fractures. Neurol Res 2013 Feb 13 [Epub ahead of print]

 

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Validity of Intervertebral Bone Cement Infusion for Painful Vertebral Compression Fractures Based on the Presence of Vertebral Mobility

In Not Only Vertebroplasty but Also Kyphoplasty, the Resolution of Vertebral Deformities Depends on Vertebral Mobility