Percutaneous vertebroplasty for osteoporotic vertebral compression fractures in the nonagenarians: A prospective study evaluating pain reduction and new symptomatic fracture rate

Study Design. A prospective observational cohort study of consecutive osteoporotic vertebral compression fractures (VCFs) in ≥90-year-old patients evaluated at a multidisciplinary, university spine center. Objective. Assess efficacy, safety, and new fracture occurrence after percutaneous vertebroplasty (PV) in a large uncontrolled cohort of ultra elderly VCF patients. Summary Of Background Data. VCFs are associated with increased morbidity and mortality. Percutaneous injection of polymethylmethacryl-ate into the fractured vertebral body, vertebroplasty, has been extensively performed as an effective minimally-invasive treatment option for VCF patients. The patient sample included consecutive, osteoporotic patients with symptomatic VCFs electing to enter the study. Methods. Baseline visual analogue scale rating, analgesic usage, duration of symptoms. Subsequent VAS ratings, analgesic utilization, and new fractures were assessed within 30 minutes after the procedure, at 2 weeks, 1 month, 3 months, 6 months, 1 year, and 2 years postprocedure. Outcome measures: Visual Analogue Scale score, analgesic utilization, patient satisfaction, cement extravasation, and new fractures. Results. A total of 123 (74% female) underwent PV for 163 VCFs. Eleven patients did not complete final follow-up at 2 years due to death unrelated to the PV procedure. The mean VAS score was 7.6 at baseline and 3.1 at 30 minutes after the procedure, and 2.3, 1.2, 1.1, 0.9, 0.8, and 0.5 at 2 weeks, 1 month, 3 months, 6 months, 1 year, and 2 years, respectively. Improvement over time was statistically significant using repeated measures analysis of variance (P < 0.05). No complications were encountered during the follow-up intervals. Thirteen new fractures were observed (10.6%) at a mean 20.8 weeks (1-52 weeks) after PV with 6 new fractures (4.9%) involving an adjacent level in 5 patients (4.1%). Conclusion. Vertebroplasty for VCFs in the very elderly appears effective and safe without increased risk of adjacent level fracture.