Predictors of outcomes of percutaneous vertebroplasty for osteoporotic vertebral fractures

Study Design. Retrospective review of all percutaneous vertebroplasties performed in the authors' institution from November 1994 to June 2002. Objective. To determine the factors affecting the outcome of percutaneous vertebroplasty for the treatment of persistent painful osteoporotic fractures. Summary of Background Data. Percutaneous vertebroplasty is an efficient procedure to treat pain due to osteoporotic vertebral fracture. However, the patient population that is most likely to benefit from this procedure is uncertain, and the inclusion and exclusion criteria for an ideal candidate have varied widely in the literature. Methods. A retrospective review of 278 percutaneous vertebroplasty procedures for osteoporotic fractures at 423 levels was performed. Sociodemographic, clinical, radiologic, and procedural data were analyzed as parameters for prognosis significance by univariate and multivariate analysis with logistic regression to estimate the strength of influence of each variable. Results. The presence of two or less symptomatic vertebrae (P < 0.03), the American Society of Anesthesiologists status I (P < 0.001), the presence of signal changes on magnetic resonance imaging (P < 0001), and the collapse of the vertebral body less than 70% (P < 0.001) were assessed as parameters for prognostic significance. Multivariate analysis also showed a significant correlation between the American Society of Anesthesiologists score and height loss of the vertebral body and the final outcome. The presence of signal changes on magnetic resonance imaging showed the highest odds ratio adjusted. Conclusions. Appropriate patient selection is essential for achieving clinical success. Better results can be expected in patients with an American Society of Anesthesiologists score of I and when the level managed is confirmed by magnetic resonance imaging and the vertebral body height loss is less than 70%.