Surgical outcome of PVP for severe middle and upper thoracic osteoporotic vertebral compression fracture

English Keywords:Percutaneous vertebroplasty  Vertebral compression fracture  Middle and upper thoracic  Osteoporosis  Transpediclar approach  Extrapedicular approach

English Abstract:

  【Abstract】 Objectives: To investigate the clinical outcome of percutaneous vertebroplasty（PVP） for middle and upper thoracic(above T6) osteoporotic severe vertebral compression fracture(SVCF). Methods: 12 patients with painful middle and upper thoracic osteoporotic SVCF treated by PVP between January 2011 and December 2012 were analyzed retrospectively. The patients included 4 males and 8 females, with a mean age of 74.5 years(61-83 years). A total of 12 vertebrae was involved in this group including T2 in 1, T3 in 3, T5 in 3 as well as T6 in 5. The mean rate of loss of vertebral height was 68%(65%-72%). The mean T value of lumbar BMD was -4.2[(-3.8)-(-5.2)]. Before operation, VAS score of back pain was 6.75±1.14, ODI was(68.58±5.70)%, anterior height(AH) of the compressive vertebral body was 0.96±0.09cm, kyphosis angle(KA) of the compressive vertebral body was 18.90°±1.03°. Bilateral transpedicular approach was used in 10 cases and bilateral extrapedicular approach in 2 cases. Results: Surgery was performed successfully on all the patients. The mean surgical time was 41min(27-51min) for 10 cases undergoing bilateral transpedicular approach and 62 minutes for 2 cases undergoing bilateral extrapedicular approach. The mean blood loss was 10ml(5-16ml). The average volume of instilling polymethylmethacrylate(PMMA) was 2.2(1.7-2.8)ml. Disc leakage of PMMA through the superior endplate incompetence was noted in one case, which was asymptomatic and free of intervention. Two days after operation, VAS of back pain was 3.17±1.03, ODI was (33.00±17.54)%, which all showed significant differences; AH was 0.98±0.11cm, KA was 19.10°±0.99°, which showed no improvement(P＞0.05). New fracture either in diseased level or adjacent level could not be found during the follow-up(range, 6 months to 1 year). At final follow-up, VAS of back pain was 3.75±0.87. ODI was (32.33±17.11)%, AH was 0.97±0.12cm, KA was 19.08°±1.00°, which remained unchanged compared with those of two days after operation(P＞0.05). Conclusions: For middle and upper thoracic SVCF, PVP can alleviate back pain effectively and safely, however, PVP is of no effect to correct the AH and KA.