vertebroplasty for a new fracture has the same prognosis ......vertebroplasty for a new fracture has...

Vertebroplasty for a New Fracture Has the Same Prognosis as the Initial procedure

Mayumi Oka, MD Yuji Numaguchi, MD, PhD Per-Lennart Westesson, MD, PhD, DDS

University of Rochester Presentation material for educational purposes only. All rights reserved. ©2002 URMC Radiology Page 1 of 13

Background

•! Approximately 80% success rate. •! Many patients return with new

fractures after the procedure.

Presentation material for educational purposes only. All rights reserved. ©2002 URMC Radiology Page 2 of 13

Study purpose

•! Assess outcome of subsequent

vertebroplasties for new fractures in patients

who were treated with vertebroplasty.

Presentation material for educational purposes only. All rights reserved. ©2002 URMC Radiology Page 3 of 13

Patients

•! 18 females •! 18 males •! Mean age 75 years (46 to 93 years) •! Initial procedures 36 (63 levels) •! Subsequent procedures 15 (21 levels)

Presentation material for educational purposes only. All rights reserved. ©2002 URMC Radiology Page 4 of 13

Etiology of vertebral fractures

•! Osteoporosis 29 patients

•! Metastasis 5 patients

•! Multiple myeloma 2 patients

Presentation material for educational purposes only. All rights reserved. ©2002 URMC Radiology Page 5 of 13

Evaluations

•! Pain 0 (no pain) 6 (extreme)

•! Medication 0 (no meds) 4 (IV narcotics)

•! Mobility 1 (ambulatory) 4 (bedridden)

Adopted from O�Brien et al. AJNR 2000; 21:1555-58

Presentation material for educational purposes only. All rights reserved. ©2002 URMC Radiology Page 6 of 13

Outcome assessment

•! Successful No to mild residual pain •! Improved Decreased pain

•! Failure No change or worse

Presentation material for educational purposes only. All rights reserved. ©2002 URMC Radiology Page 7 of 13

68 y.o. male with COPD on steroids

Post op CT

T4

T5

L5

L3

T1W post Gd

T4 T5

L3

L3

Presentation material for educational purposes only. All rights reserved. ©2002 URMC Radiology Page 8 of 13

2 months after first procedure

L1 T12

T1W post Gd Post op CT Presentation material for educational purposes only. All rights reserved. ©2002 URMC Radiology Page 9 of 13

After 4 procedures

Presentation material for educational purposes only. All rights reserved. ©2002 URMC Radiology Page 10 of 13

Results

Outcome Initial N=36

Subsequent N=15

Successful 72 % 73 %

Improved 19 % 27 %

Failure 8 % 0 %

Presentation material for educational purposes only. All rights reserved. ©2002 URMC Radiology Page 11 of 13

Pre vs. Post

Pain Medication Mobility Initial 4.9 ! 1.6* 2.7 ! 1.3* 2.6 ! 1.8* Procedure Subsequent 4.3 ! 1.3* 2.7 ! 1.1* 1.9 ! 1.1* Procedure

Wilcoxon rank sum test: p<0.05

Presentation material for educational purposes only. All rights reserved. ©2002 URMC Radiology Page 12 of 13

Conclusion

Vertebroplasty for a new fracture has

the same prognosis as the initial

procedure

Presentation material for educational purposes only. All rights reserved. ©2002 URMC Radiology Page 13 of 13