Prospective, double-cohort study. To evaluate conservative and percutaneous vertebroplasty (PV) management of osteoporotic vertebral fractures. PV is an elective alternative to conservative management for the treatment of a painful osteoporotic vertebral fracture. We performed a prospective study consisting of 101 consecutive patients who underwent PV and 27 patients who refused PV treatment and were managed conservatively. We used a data evaluation and outcomes system that was developed to evaluate the outcomes of surgical intervention. Patients that elected for PV as a treatment of their fractures had significantly more pain and functional impairment before the procedure than the patients of the conservative group (P < 0.001). The pain, functional, and general health scores of the PV group were improved from the preoperative mean values (P < 0.001) in all postoperative periods. Compared with the conservative treatment group, there was a significant difference at month 3. However, no statistical differences on function were observed between these groups at 6 months and 1 year posttreatment. PV demonstrated a rapid and significant relief of pain and improved the quality of life. PV election for treatment of painful osteoporotic vertebral fracture after 6 weeks of conservative treatment was based on pain and functional impairment.

Study Design. Retrospective study. Objective. To identify fracture morphology-dependent risk factors for the occurrence of cement leakage during percutaneous vertebroplasty. Summary of Background Data. Extravertebral cement leakage is the most frequently reported complication and represents a major risk after vertebroplasty and balloon kyphoplasty. Despite the frequent occurrence of cement leakage and potentially dangerous complications and sequelae, there are few reports that examine its predictors. Methods. Retrospective review of 194 consecutive patients who underwent percutaneous vertebroplasty for painful osteoporotic or malignant vertebral fracture. The influences of several parameters that might affect the occurrence of cement leakage were assessed using univariate and multivariate analyses. Cement leakage was assessed using computed tomography scanning and classified into 4 different types with different potential sequelae: through the basivertebral vein, through the segmental vein, through a cortical defect, and intradiscal leakage. Results. Leakage of cement was detected in 209 of the 272 treated vertebrae (76.83%). The most common types of leakage detected were through the basivertebral vein (43.38%) and the segmental vein (42.27%). None of the evaluated variables showed a statistically significant effect. Only the absence of Kummell disease (P = 0.063) and a lower severity grade of collapse (P = 0.068) approached statistical significance. For basivertebral vein leakages, the location at the thoracolumbar level and the absence of Kummell disease (P < 0.05) were strong predictive factors for cement leakages. For segmental vein leakages, the odds decreased as the severity grade of collapse increased (P = 0.008). Conclusion. Each different vertebral fracture pattern has its own risk factors for cement leakage. For certain types of leakage, Kummell avascular necrosis as a protective factor and fracture severity grade with paradoxical effect have each demonstrated influence in the occurrence of cement leakage. Level of Evidence: 4

Retrospective review of all percutaneous vertebroplasties performed in the authors’ institution from November 1994 to June 2002. To determine the factors affecting the outcome of percutaneous vertebroplasty for the treatment of persistent painful osteoporotic fractures. Percutaneous vertebroplasty is an efficient procedure to treat pain due to osteoporotic vertebral fracture. However, the patient population that is most likely to benefit from this procedure is uncertain, and the inclusion and exclusion criteria for an ideal candidate have varied widely in the literature. A retrospective review of 278 percutaneous vertebroplasty procedures for osteoporotic fractures at 423 levels was performed. Sociodemographic, clinical, radiologic, and procedural data were analyzed as parameters for prognosis significance by univariate and multivariate analysis with logistic regression to estimate the strength of influence of each variable. The presence of two or less symptomatic vertebrae (P < 0.03), the American Society of Anesthesiologists status I (P < 0.001), the presence of signal changes on magnetic resonance imaging (P < 0001), and the collapse of the vertebral body less than 70% (P < 0.001) were assessed as parameters for prognostic significance. Multivariate analysis also showed a significant correlation between the American Society of Anesthesiologists score and height loss of the vertebral body and the final outcome. The presence of signal changes on magnetic resonance imaging showed the highest odds ratio adjusted. Appropriate patient selection is essential for achieving clinical success. Better results can be expected in patients with an American Society of Anesthesiologists score of I and when the level managed is confirmed by magnetic resonance imaging and the vertebral body height loss is less than 70%.

Calcium phosphate cements (biocements) are alternative materials for use in vertebral augmentation procedures, and are a potential solution to problems associated with polymethylmethacrylate (PMMA) cements. The aim of this study is to demonstrate the utility of percutaneously injected biocements compared with PMMA in a validated animal model of osteoporosis. Fortyseven augmentation procedures were performed on 11 osteoporotic sheep. 9 vertebrae were augmented with PMMA and 38 with a biocement. The animals were killed in four groups: at 7 days, 3 months, 6 months, and 1 year after intervention. Radiological study and TC of the pieces were obtained to evaluate for leakage, cement diffusion, and integration. In total, 26 biomechanic studies and 27 histomorphometry analyses were performed, included control vertebrae. In 20.9% of the vertebrae, the hole was empty at sacrifice. The pattern of fracture was heterogeneous, and cement augmentation did not increase vertebral strength or decrease vertebral stiffness compared to control vertebrae, with neither PMMA or biocement. The rate of remodeling of the biocement was not predictable. In the single majority, there is peripheral remodeling, staying the volume of injected biocement stable. Even though this animal model may not be useful to analyze the biomechanical pattern of treated vertebrae, it demonstrates that the percutaneous use of biocements in vertebral augmentation techniques is not predictable. This is one reason not to recommend its use presently as a substitute for PMMA in vertebral reinforcement procedures.