To The Editor:
Previously we reported that in subjects with painful osteoporotic
vertebral compression fractures (VCFs) rapid relief of pain and
improvement in quality of life following percutaneous vertebroplasty (PV)
was durable up to 6 months(1) and that these outcomes were unrelated to
vertebral height restoration(2). Herein we report the one year follow up of our original cohort (46 subjects) to which the next 30 consecutive subjects seen by us for PV have been added. All 76 subjects provided informed consent and were enrolled in the original study, the design and implementation of which were approved and monitored by our institutional IRB.
In 76 subjects (104 osteoporotic VCFs) pain
(VAS; 0-10) improved substantially by the first postoperative day (ΔVAS =
-4.9, p<0.001) and remained improved at 1 year (ΔVAS= -4.0 compared
with preoperative pain, p=0.001). In subjects with dynamically mobile
(n=35) and clefted (n=36) VCFs VAS increased slightly from postoperative
day one to 1 year (ΔVAS = +1.5 and +1.2 respectively, p ≤ 0.002) but VAS
did not change in subjects with fixed or non-clefted VCFs.
All five
domains of the Osteoporosis Quality of Life Questionnaire (OQLQ) were
improved 2 weeks post-operatively and remained improved at 1 year (p ≤
0.004). OQLQ outcome was not consistently influenced by the presence or
absence of any vertebral height restoration achieved at PV. Multivariate
analysis of various demographic factors suggested that glucocorticoid use
(ever) predicted less favorable VAS (p = 0.001) and quality of life
outcomes (p < 0.05 for Symptoms, Activities of Daily Living and Leisure
OQLQ domains) at 1 year.
There were 12 deaths within 1 year of PV due to
previously diagnosed terminal cancer, end stage lung or renal disease. No
death was attributable to PV. One deep venous thrombosis (DVT) occurred
within 1 month of PV in a woman with alcoholic cirrhosis and a previous
history of DVT. Only 5 incident VCFs (2 adjacent, 3 remote) occurred in 4
patients (5.3%) within one year of PV.
We conclude that PV can be
performed safely and effectively in frail elderly patients and that improvements in
pain and quality of life are durable for up to 1 year. Patient factors
(even glucocorticoid use) and vertebral factors (dynamic mobility, clefts)
may portend less favorable long-term outcomes and should be carefully
considered in future PV trials.
References:
1. McKiernan FE, Faciszewski T, Jensen . Quality of life following
percutaneous vertebroplasty, J Bone Joint Surg (Am) 2004;86(12):2600-6.
2. McKiernan FE, Faciszewski T, Jensen R. Does height restoration
achieved at vertebroplasty matter? J Vasc Interv Radiol; 2005; 16:973-9.
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