Osteoporotic compression fractures: outcomes after single- versus multiple-level percutaneous vertebroplasty

PURPOSE: To compare single- and multiple-level percutaneous vertebroplasty (PV) in terms of pain relief, activity level, and analgesic use in patients with osteoporotic vertebral compression fractures (VCFs). MATERIALS AND METHODS: Institutional review board approval and informed consent were obtained, and the study was HIPAA compliant. One hundred seventy-three patients (mean age at treatment, 73.8 years +/- 11.9 [standard deviation]) with 422 symptomatic osteoporotic VCFs underwent 204 treatment sessions for over 4 years. Pain immediately before and after PV was measured by using a visual analogue scale (VAS). Pain degree, activity level, and analgesic use were assessed at 2 weeks and 1, 3, 6, 12, and 24 months after PV by using telephone interview questionnaires. Data were analyzed by using a combination of paired t tests, analysis of variance, contingency tables, and chi2 tests. RESULTS: Findings of 172 PV treatment sessions for 149 patients (mean age at treatment, 73.4 years +/- 12), 110 (74%) of whom were women, were assessed; 32 treatment cases were lost to follow-up or lost owing to death. A single fracture level was treated at 65 sessions; two fracture levels, at 52 sessions; and three or more fracture levels, at 55 sessions. The mean VAS pain score decreased significantly (P < .001), from 76 +/- 21 before to 19 +/- 27 immediately after PV. Of the outcomes reported at 24 months, 82% (64 of 78 treatment sessions) were marked to complete resolution of the initial pain, 51% were complete cessation of analgesic use, and 51% were increased activity levels. These results did not differ greatly over time or when stratified into groups according to the number of fracture levels treated. CONCLUSION: PV performed at a single fracture level and that performed at multiple fracture levels were equally effective in facilitating long-term pain relief, increased activity level, and decreased analgesic use in patients with osteoporotic VCFs.