Fergus Mckiernan, MD1, Tom Faciszewski, MD1 and Ron Jensen, PT1
1 Center for Bone Diseases (F.M.) and Department of Orthopedic Spine Surgery (T.F. and R.J.), Marshfield Clinic, 1000 North Oak, Marshfield, WI 54449. E-mail address for F. McKiernan: firstname.lastname@example.org. E-mail address for T. Faciszewski: email@example.com. E-mail address for R. Jensen: firstname.lastname@example.org
Percutaneous vertebroplasty may be indicated when a patient with a painful osteoporotic vertebral compression fracture remains intolerably symptomatic in spite of comprehensive, nonoperative management. Relief of pain and quality of life following percutaneous vertebroplasty, however, remain incompletely defined. We investigated these outcomes with use of a visual analog scale and a validated, osteoporosis-specific health-related quality-of-life instrument.
We performed a prospective study of consecutive patients who underwent percutaneous vertebroplasty. At the time of enrollment, all patients completed the Osteoporosis Quality of Life Questionnaire, a validated thirty-item, five-domain, 7-point response-option instrument that measures health-related quality of life in osteoporotic women with back pain due to vertebral compression fracture. At two weeks, two months, and six months postoperatively, all patients completed a validated extraction of the Osteoporosis Quality of Life Questionnaire. The minimal, clinically important difference in this 7-point scale is 0.5 unit per question. To assess pain, a visual analog scale (ranging from 1 to 10) was completed preoperatively, one day postoperatively, and at each evaluation thereafter.
Forty-six consecutive patients (thirty-two women and fourteen men) underwent forty-nine percutaneous vertebroplasty procedures for the treatment of sixty-six vertebral compression fractures. The mean age of the patients was 74.3 years. The mean fracture age was 2.5 months. The mean pain rating decreased from 7.7 preoperatively to 2.8 one day after the vertebroplasty (p < 0.001), and it remained substantially improved at two weeks, two months, and six months postoperatively (p < 0.001). All five domains of the Osteoporosis Quality of Life Questionnaire were improved at two weeks postoperatively and remained improved at each evaluation point through six months (p 0.007). Multivariate analysis demonstrated no consistent correlation between postoperative pain relief or any postoperative Osteoporosis Quality of Life Questionnaire domain score and gender, smoking history, previous or current steroid use, bone mineral density, dynamic mobility, or the presence of an intravertebral cleft. Immediate postoperative pain relief was weakly and positively associated with age (p < 0.03). Four incident vertebral compression fractures occurred in three (6.5%) of the forty-six patients, and five patients died within six months after the vertebroplasty. No deaths or serious adverse events appeared to be related to vertebroplasty.
Rapid and substantial relief of pain and improvement in the quality of life are observed following percutaneous vertebroplasty, and these improvements are maintained for at least six months. Percutaneous vertebroplasty can be performed safely in frail, elderly patients, with no apparent increase in the incidence of fractures postoperatively.
The Journal of Bone and Joint Surgery (American). 2004;86:2600-2606.