He Shi-Cheng, Teng Gao-Jun, Deng Gang, Fang Wen, Guo Jin-He, Zhu Guang-Yu, Li Guo-Zhao
Department of Radiology, Zhong-Da Hospital, Southeast University, Nanjing, China.
Spine (Phila Pa 1976). 2008 Mar 15;33(6):640-7. doi: 10.1097/BRS.0b013e318166955f.
A retrospective study was performed in patients with a repeat percutaneous vertebroplasty (PV) at the vertebral levels previously undergoing vertebroplasty.
Our purpose of this study is to examine if a repeat PV is effective on pain-relief at the vertebral levels previously undergoing vertebroplasty.
Although pain-relief is usually high with the treatment of PV in the painful osteoporotic vertebral compression fractures, there are still about 5% to 22% of such patients experiencing no improvement on pain after PV. A repeat PV at the same vertebrae previously treated with PV may be an option for these patients without a pain-relief.
Out of 334 procedures of PV in 242 patients with osteoporotic vertebral compression fractures from October 2000 to June 2006 in our institute, 15 vertebrae in 15 patients with unrelieved pain in 4 to 32 days after an initial PV were treated with a repeat vertebroplasty. The clinical outcomes were assessed by measurements of visual analog scale, and the imaging features were analyzed pre- and postprocedure.
The mean volume of Polymethylmethacrylate injected in each vertebra was 4.0 mL (range, 1.5-9 mL) in the repeat PV. During the first month of follow-up after repeat PV in this series, a mean visual analog scale scores of the pain level was reduced from 8.6 (range, 7-10) preprocedure to 1.67 points (range, 0-4) postprocedure, with a mean reduction of 6.93 points (range, 4-8). Complete and partial pain relief were reached in 11 (73%) and 4 patients (27%), respectively in a mean follow-up of 15 months. No serious complications related to the procedures occurred, but asymptomatic Polymethylmethacrylate leakage around vertebrae was demonstrated on radiograph or computed tomography in 2 patients.
The outcomes of this series suggest that repeat PV is effective at the same vertebral levels in patients without pain-relief who underwent previous PV. Absent or inadequate filling of cement in the unstable fractured areas of the vertebral body may be responsible for the unrelieved pain after the initial PV.
对先前接受过椎体成形术的椎体水平进行重复经皮椎体成形术（PV）的患者进行了一项回顾性研究。
本研究的目的是检验重复PV对先前接受过椎体成形术的椎体水平的疼痛缓解是否有效。
尽管在治疗疼痛性骨质疏松性椎体压缩骨折时，PV治疗的疼痛缓解率通常较高，但仍有5%至22%的此类患者在PV治疗后疼痛没有改善。对于这些疼痛未缓解的患者，在先前接受过PV治疗的同一椎体上进行重复PV可能是一种选择。
在2000年10月至2006年6月期间，我院对242例骨质疏松性椎体压缩骨折患者进行了334例PV手术，其中15例患者在初次PV后4至32天疼痛未缓解，对其15个椎体进行了重复椎体成形术治疗。通过视觉模拟量表测量评估临床结果，并对术前和术后的影像学特征进行分析。
在重复PV中，每个椎体注入的聚甲基丙烯酸甲酯平均体积为4.0 mL（范围为1.5 - 9 mL）。在本系列重复PV后的第一个月随访期间，疼痛水平的平均视觉模拟量表评分从术前的8.6（范围为7 - 10）降至术后的1.67分（范围为0 - 4），平均降低6.93分（范围为4 - 8）。在平均15个月的随访中，分别有11例（73%）和4例（27%）患者实现了完全和部分疼痛缓解。未发生与手术相关的严重并发症，但2例患者的X线片或计算机断层扫描显示椎体周围有无症状的聚甲基丙烯酸甲酯渗漏。
本系列结果表明，重复PV对先前接受过PV但疼痛未缓解的患者在同一椎体水平是有效的。椎体不稳定骨折区域骨水泥填充缺失或不足可能是初次PV后疼痛未缓解的原因。
