Clinical characteristics and countermeasures of osteoporotic vertebral fractures treated with percutaneous vertebroplasty

Objective To explore clinical the characteristics and countermeasures of osteoporotic vertebral fractures treated with percutaneous vertebroplasty. Methods From March 2005 to March 2008,64 patients (totally 86 vertebra) with osteoporotic vertebral fractures undergoing percutaneous vertebroplasty were retrospectively analyzed. The level of fracture was between T5 to L5. The symptomatic fractured vertebrae were determined with combination of regional pain, X-rays and MR images. The postoperative effect were evaluated by the visual analog score (VAS) and Oswestry disability index (ODI). Results All the patients were followed up 12 - 23 ( 13.40 ± 1.03 ) months. The VAS decreased from (8.3 ± 1.2) scores to bdfore surgery (2.3 ± 1.4) scores after surgery and to (2.5 ± 1.1 ) scores at the last follow-up time(P ＜ 0.01 ). The ODI decreased from (62.0 ± 2.3 ) scores before surgery to (23.1 ± 2.5 ) scores after surgery and to ( 26.3 ±2.4) scores at the last follow-up time (P ＜0.01). The back pain of all patients were relieved to different degrees postoperatively. No severe complications including pulmonary embolism occurred. Conclusions The key point is to find the symptomatic fractured vertebrae not only based on preoperative X-rays but also the MR images, especially fat-compressing MR images. Only when the fractured vertebrae demonstrate low intensity on T1WI MR image and high intensity on T2WI or fat-compressing MR image can be considered new fractures. The injection should reach the new fractured part and if necessary the bilateral approaches should be considered and the injection can be separated for several steps in multi-segments fracture. PMMA should be injected after the bone cements are solid enough so as not to develop complications such as pulmonary embolism. Key words: Osteoporosis;  Spinal fractures;  Vertebroplasty