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Institute for Cancer Research and Treatment Candiolo (TURIN) - Italy Long-Term Data for 884 Patients Show Vertebroplasty for Osteoporotic Spinal Fractures.

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Presentation on theme: "Institute for Cancer Research and Treatment Candiolo (TURIN) - Italy Long-Term Data for 884 Patients Show Vertebroplasty for Osteoporotic Spinal Fractures."— Presentation transcript:

1 Institute for Cancer Research and Treatment Candiolo (TURIN) - Italy Long-Term Data for 884 Patients Show Vertebroplasty for Osteoporotic Spinal Fractures Provides Dramatic Pain Relief, Greatly Decreases Disability Giovanni Carlo ANSELMETTI, MD

2 Percutaneous Vertebroplasty STUDY DESIGN We prospectively evaluated back-pain improvement, new fracture rate and complications in a large series of Osteoporotic Patients underwent to Percutaneous Vertebroplasty for vertebral fracture refractory to conservative medical treatment

3 Patients Populations 884 Patients (750 female male mean age 73,1 years ) 639 Primary Osteoporosis (72,3%) 639 Primary Osteoporosis (72,3%) 245 Secondary to Steroidal therapy (27,7%) 245 Secondary to Steroidal therapy (27,7%) Treated on 3954 Vertebrae Treated on 3954 Vertebrae All procedures in Local anesthesia All procedures in Local anesthesia Patients discharged from the Hospital the same procedural day Patients discharged from the Hospital the same procedural day

4 Clinical Evaluation Pain was evaluated using a 11-point Visual Analogic Scale from 0 (no pain) to 10 (worst experienced pain) before and after the procedure. Disability improvement was evaluated by external Brace support and Oswestry Disability Questionnaire before and after Vertebroplasty If patients reported back-pain recurrence during follow- up clinical interview and MRI were performed to investigate new vertebral fracture

5 Visual Analog Scale Pre e Post VTP 884 patients Follow-up up to 52 months P< Wilcoxon signed rank Test SD±1,5 SD±1,8 845/884 patients (95,6%) reported backpain improvement

6 Quality of Life after PV Brace support Follow-up up to 52 months P< McNemar’s Test

7 Quality of Life Oswestry Disability Questionnaire 884 Pts P< Paired t test SD ±13,5% SD±6,9%

8 New Fractures in Osteoporosis 884 Patients - Follow-up up to 52 months During follow-up all patients were invited to contact us whenever backpain occurred again after PV. MR and plain radiograms showed a new vertebral fractures in: 106 patients (12%) Occurred 15 days to 36 months (mean 9,4±8,7 months) after previous Vertebroplasty They were all successfully retreated!

9 New Fractures in Osteoporosis Fracture on Contiguous vertebra 73/106 patients (68,9%) Pts RetreatedFract. on Contiguous vertebra% Binomial exact Test ,9 Two-tail P<0,001 Highly significant

10 RETREATMENTS in Osteoporosis New Fracture during 18 months Follow-up Vertebroplasty vs. Placebo & Teriparatide Osteoporotic Pts with 1 or more vertebral collapses at baseline New Fracture During 18 months % Chi-square Vertebroplasty Personal Series ,7 Placebo Lindsay et al. Arch Intern Med 2004; 164: ,9 P=0.04 Signifcant difference! 20µG Teriparatide Lindsay et al. Arch Intern Med 2004; 164: ,2 P=0.3 No difference! 40µG Teriparatide Lindsay et al. Arch Intern Med 2004; 164: ,4 P=0.18 No difference!

11 COMPLICATIONS 18/884 patients (2%) 12 (1,4%) asymptomatic pulmonary embolism 12 (1,4%) asymptomatic pulmonary embolism 6 (0,7%) nerve root irritation successfully treated by local steroidal injection 6 (0,7%) nerve root irritation successfully treated by local steroidal injection Vertebroplasty was completed in all patients without any major complications

12 CONCLUSIONS Vertebroplasty is safe and effective in the treatment of back-pain due to osteoporotic vertebral collapses. Vertebroplasty is safe and effective in the treatment of back-pain due to osteoporotic vertebral collapses. After Vertebroplasty patients can increase mobility and improve their quality of life. After Vertebroplasty patients can increase mobility and improve their quality of life. New fracture rate seems to be similar to not PV- treated osteoporotic pts reported by literature. New fracture rate seems to be similar to not PV- treated osteoporotic pts reported by literature. Our data suggest that Vertebroplasty should always be proposed to patients when conservative medical treatment fails. Our data suggest that Vertebroplasty should always be proposed to patients when conservative medical treatment fails.


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