Pain relief and associated factors in patients undergoing vertebroplasty due to osteoporotic vertebral fracture

Abstract

Background: Osteoporotic vertebral fracture (OVF) is a common spinal fracture in the elderly population treated with conservative or surgical techniques. Patients with such fractures may experience chronic pain due to nonunion and instability, deformity with kyphosis and neurologic symptoms due to neural compression. Surgical interventions have definite roles in treatments especially when conservative therapy fails. Cement augmentation in forms of vertebroplasty and kyphoplasty or even surgical fixation with or without column reconstruction are among our armamentarium to deal with problems arising during the treatment of these patients. Methods: We entered patients with OVF who did not respond to conservative treatments for more than 4 weeks and were candidates for vertebroplasty. Pain Visual Analog Scale (PVAS) was assessed for patients before the procedure, in the first month and 6 months after surgeries. We also analyzed factors including time passed from fractures, amounts of injected cement, age, sex, types of fractures, segmental kyphosis and sites of fractures. Data were collected and analyzed using SPSS software version 24. Results: A total number of 140 patients entered. The mean age of the patients was 64.90 +/- 7.97 years. Mean preoperative pain level was 8.35 +/- 0.97 points on VAS (0-10) score. The mean Post-operative VAS score after one month and after six months were 4.65+0.66 and 5.28 +/- 0.75 respectively. The mean consumed cement volume was 5.77+1.40 ml. Cement volume of more than 5 ml was injected for 53.6 of patients. 78.7 of fractures were located in T10-L2 levels (thoracolumbar fractures). 14.2 of fractures in L3-L5 (lumbar fractures) and 7.1 in T4-T9 (thoracic fractures). 53.6 of the patients had kyphosis levels below 20 degrees. Reduction of pain in patients younger than 60 years was more than patients older than 60 years but both groups indicated pain reduction (P<0.001). The end-plate fracture had a higher likelihood of pain relief compared with burst or retropulsed fractures (OR=1.161). Patients with thoracolumbar fractures had higher chances of pain reduction compared with other locations (OR=1.870). Kyphosis less than 20 degrees and also cement volume more than 5 ml had also significant effects on reducing the pain after surgeries (OR=2.054 and OR=2.412 respectively (P<0.05)). Conclusion: Vertebroplasty is an effective option in treating patients with OVF who have not respond to conservative treatment. Factors such as younger age, OVFs involving either end-plates, more than 5 ml of cement injection, segmental kyphosis below 20 degrees and thoracolumbar fractures are associated with better results for pain amelioration.