What are the predictors of clinical success after percutaneous vertebroplasty for osteoporotic vertebral fractures?

Abstract

Objectives

Osteoporotic vertebral fractures are responsible for acute pain and disability that may persist for more than 2 months. We wanted to identify predicting factors for mid-term outcome after vertebroplasty.

Methods

We included consecutive patients who underwent vertebroplasty for fragility fractures with persistent and intense pain between January 2014–June 2016. Outcome was assessed by an independent clinician after 1 month using a standardized questionnaire. Patients were classified as having either a favorable or a poor outcome. Presence of an intravertebral cleft and bone oedema mean signal intensity was assessed by an independent radiologist blinded to the clinical data. Pre-intervention clinical or radiological factors were analysed as predictors for outcome.

Results

In the 78 included patients (females 71%, age 75 ± 8.3 years), 61.5% had a favourable outcome. When vertebroplasty was performed within 2 months after fracture, the outcome was favourable in 19 patients (39.6%) and poor in five (16.7%; estimate for favourable outcome: OR = 4.1, 95% CI 1.2–13.8, p = 0.021). Absence of intravertebral cleft on pre-intervention imaging was also a predictor of favourable outcome (OR = 3.7, 95% CI 1.2–11.8, p = 0.024). On pre-intervention MRI, vertebral body oedema intensity signal did not influence the outcome.

Conclusions

In patients with persistent and intense pain after an osteoporotic vertebral fracture, early intervention and absence of intravertebral cleft were predictors of favourable outcome at 1 month after vertebroplasty.

Key Points

• Performing vertebroplasty within 2 months following a fragility fracture increases success rate.

• Presence of an intravertebral cleft at baseline is a predictor of poor mid-term outcome.

• A pre-intervention MRI should be performed to ascertain the indication of vertebroplasty.