ROLE OF PERCUTANEOUS VERTEBROPLASTY IN VERTEBRAL COMPRESSION FRACTURES: EFFICACY AND SAFETY

Background: Percutaneous Vertebroplasty (PVP) is a minimally invasive interventional procedure performed by injecting bone cement or other therapeutic material into a painful osteoporotic or neoplastic compression fracture for pain or disability improvement. There is conflicting evidence regarding the use of vertebroplasty in osteoporotic vertebral compression fractures (VCFs) in the available literature. Objectives: To evaluate the efficacy and safety of Percutaneous Vertebroplasty in painful vertebral compression fractures in terms of pain alleviation and disability improvement, and thereby, study the profile of complications. Study design: Prospective observational study Study Participants: Patients with clinically symptomatic VCFs, who received various forms of treatment (interventional/conservative) were enrolled for the study. Patients who met the inclusion/exclusion criteria were finally selected. Methodology: Out of the selected patients, two groups were made, one who received the Intervention (PVP) and another group who received conservative management (Bed rest, medications, physiotherapy, etc.). Out of 31 patients selected, 11 were treated by PVP and 20 were treated by conservative management. These patients were followed up at 1-month, 3-month and 6-month intervals to record the Visual analog pain scores (VAS), Ronald Morris disability scores (RDQ) and any complication. Results: VAS scores in the vertebroplasty group decreased from (8.09±0.539) to (3.64 ± 0.674) at 1-month to (3.27±1.009) at 3-month to (3.09±0.831) at 6-month. VAS scores also decreased in the conservative group from (7.6±0.598) to (5.95±0.999) at 1-month to (5.1±1.294) at 3-month to (5.15±1.424) at 6-month. Vertebroplasty group showed the steep fall (-4.45) in VAS values as compared to a gradual decrease in VAS (-1.65) in the conservative group at 1 month follow up, concluding that conservative treatment has a slower effect on pain relief compared with the early response after PVP. Disability scores (RDQ) follow a similar trend with early and better improvement in the vertebroplasty group. RDQ scores: Vertebroplasty group (18.45±1.572 at baseline to 12.27±1.421 at 1-month to 11.82±1.079 at 3-month to 11.82±1.471 at 6-month), Conservative group (17.95±1.146 at baseline to 14.3±1.418 at 1-month to 12.9±1.518 at 3-month to 12.85±2.207 at 6-month). Subgroup analysis showed more benefit in malignant VCFs treated by PVP. The procedure was largely uneventful. An immediate complication was noted in one patient with cement extravasation into the venous channels, however, the patient showed pain and disability improvement without any adverse effects. Furthermore, no additional complication was noted during the follow-up period in any other patient. Conclusion: Percutaneous Vertebroplasty provides early and significant pain and disability improvement in vertebral compression fractures to comparison to conservative management. Implication: Minimal invasive technique for pain relief in osteoporotic and malignant vertebral compression fractures.