Risk factors for new vertebral fractures after percutaneous vertebroplasty in patients with osteoporosis: a prospective study.

PURPOSE: To determine the risk factors for new vertebral compression fractures (VCFs) following percutaneous vertebroplasty (PV) in patients with osteoporosis. MATERIALS AND METHODS: This prospective study included 132 consecutive patients with osteoporosis treated with PV in a single institution over 46 months from March 2005 to December 2008. Multivariable logistic regression and univariate analysis were employed to identify risk factors for new VCFs after PV, including patient demographic data, parameters of the initial and new fractured vertebrae, procedure-related information, and follow-up data. RESULTS: During the follow-up period (22.4 months ± 12.1), 80 new vertebral fractures occurred in 36 (27.3%) patients. Multivariate analysis showed that number of VCFs per time frame, computed tomography (CT) value of nonfractured vertebrae (T11-L2), activity level after discharge, duration of follow-up, and cement distribution in the inferior part of the vertebral body or close to the endplate were statistically correlated with new fractures (odds ratios, 2.63, 0.96, 3.59, 1.00, 0.30, and 0.05; P = .006, P = .001, P = .007, P = .004, P = .021 and P = .029). Univariate analysis showed preexisting old VCFs were correlated with new VCFs (P = .045). Subsequent compression fractures in adjacent vertebrae (45 of 80) occurred more frequently and sooner than nonadjacent vertebral fractures (both P < .05). CONCLUSIONS: The incidence of new VCFs after PV is relatively high and affected by several risk factors that are related to both the PV procedure and the natural course of osteoporosis.

[Influencing factors of long-mid term efficacy following percutaneous vertebroplasty in patients with osteoporosis].

OBJECTIVE: To determine the therapeutic efficacy and the influencing factors for the long/middle-term outcomes of percutaneous vertebroplasty (PVP) in the treatment of painful osteoporotic vertebral compression fractures (OVCFs). METHODS: This prospective study recruited a total of 131 consecutive OVCF patients treated with PVP at a single institution from March 2005 to December 2009. There were 106 females and 25 males. Pre- and postoperative evaluations included a visual analog scale (VAS) for pain, the Roland-Morris disability questionnaire (RDQ) scores and patient activity levels. Various factors probably correlated with long-mid term efficacy were also analyzed. RESULTS: Both VAS and RDQ scores decreased significantly (P < 0.05). And the activity levels showed significant post-therapeutic improvement (P < 0.01); Univariate and multivariate analysis showed that the influencing factors for the long/middle-term efficacy were age, number of OVCF(s) per time, activity level after discharge and newly occurring OVCF (Z = -2.03, -2.68, 5.38 and -1.73; P = 0.043, 0.007, 0.001 and 0.034 respectively). CONCLUSION: PVP is an efficient pain-relieving procedure. The long/middle-term efficacy after PVP is mostly correlated with both the patient age and the natural course of underlying conditions.

[Long-term outcomes of percutaneous lumbar discectomy and microendoscopic discectomy for lumbar disc herniation].

OBJECTIVE: To evaluate the long-term effects of percutaneous lumbar discectomy (PLD) and microendoscopic discectomy (MED) in treatment of lumbar disc herniation. METHODS: A questionnaire survey by letter and telephone was conducted among 104 patients undergoing PLD and 82 patients undergoing MED during January 2000 to March 2002, to investigate the Oswestry disability index (ODI), Short Form-36 (SF-36) score, and Japanese Orthopedic Association (JOA) score. RESULTS: The excellent/good rate (ODI score=0-20%) of the MED group was 79.27%, significantly higher than that of the PLD group (71.15%, P=0.0397). However, longer The hospitalization duration of the MED group was 11, 6 d, significantly longer than that of the PLD group (7.9 d, P<0.01), and the mean cost of the MED group was, significantly higher than that of the PLD group (P<0.01). Long-term complications were observed in 3 patients of the MED group (3.49%) while none in the PLD group. CONCLUSION: Both PLD and MED are minimally-invasive-technique with a long-term efficacy and safety on lumbar disc herniation. Although the long-term outcome of the MED group is better than PLD, the complication rate, hospitalization duration, and cost of the MED group are higher.

Long-term outcomes of patients with lumbar disc herniation treated with percutaneous discectomy: comparative study with microendoscopic discectomy.

We assessed the long-term outcomes of patients with lumbar disc herniation treated with percutaneous lumbar discectomy (PLD) or microendoscopic discectomy (MED). A retrospective study was performed in consecutive patients with lumbar disc herniation treated with PLD (n = 129) or MED (n = 101) in a single hospital from January 2000 to March 2002. All patients were followed up with MacNab criteria and self-evaluation questionnaires comprising the Oswestry Disability Index and Medical Outcomes Study 36-Item Short-Form Health Survey. Several statistical methods were used for analyses of the data, and a p value of <0.05 was considered to be statistically significant. A total of 104 patients (80.62%) with PLD and 82 patients (81.19%) with MED were eligible for analyses, with a mean follow-up period of 6.64 +/- 0.67 years and 6.42 +/- 0.51 years, respectively. There were no significant differences between the two groups in age, number of lesions, major symptoms and physical signs, and radiological findings. According to the MacNab criteria, 75.96% in the PLD group and 84.15% in the MED group achieved excellent or good results, respectively, this was statistically significant (p = 0.0402). With the Oswestry Disability Index questionnaires, the average scores and minimal disability, respectively, were 6.97 and 71.15% in the PLD group and 4.89 and 79.27% in the MED group. Total average scores of Medical Outcomes Study 36-Item Short-Form Health Survey were 75.88 vs. 81.86 in PLD group vs. MED group (p = 0.0582). The cost and length of hospitalization were higher or longer in MED group, a statistically significant difference (both p < 0.0001). Long-term complications were observed in two patients (2.44%) in the MED group, no such complications were observed in the PLD group. Both PLD and MED show an acceptable long-term efficacy for treatment of lumbar disc herniation. Compared with MED patients, long-term satisfaction is slightly lower in the PLD patients; complications, hospitalization duration, and costs in PLD group are also lower.