Table 21:
Clinical Outcomes of Studies Evaluating the Effectiveness of Vertebral Augmentation for Sacral Vertebral Compression Fractures
| Author, Year Country |
Patients, N Risks VB Levels Treated, n |
Pain Intensity, VAS Mean ± SD (Range)a |
Analgesic Use | Mobility | Pain-Related Disability Health-Related Quality of Life |
|---|---|---|---|---|---|
| Vertebroplasty for Sacral Vertebral Compression Fractures | |||||
| Basile et al, 2010153 Italy |
8 patients VP in multiple myeloma; RFA and VP in 2 patients 6 patients had persistent pain despite prior cementoplasty |
Baseline 7.5 (6.0–10) Post-intervention (24 hours) 2.1 (0–5.0) |
Baseline Fentanyl: n = 7 Morphine and fentanyl: n = 1 Post-intervention Analgesia use decreased in all patients No analgesics: n = 3 Decreased fentanyl dose, 75 or 100 μg/h to 25 μg/h: n = 4 Decreased fentanyl 75 μg/h and morphine 60 μg/h via epidural catheter to fentanyl 50 μg/h: n = 1 |
Baseline All had difficulty walking due to pain Post-intervention NR |
NR |
| Botton et al, 2012157 France |
42 patients VP in 10 long bone, 13 spinal [T or L], 20 pelvis; 36 patients had PRT before or after VP |
Treatment efficacy score; Good result—reduction of > 10% of opioid dose OR resumption of walking in those formerly unable to OR decreased pain at rest or during effort of > 1 point on VAS OR concordant opinion of patient or physician Partial result—pain relieved only moderately or temporarily Failure—unrelieved pain Post-intervention Good result: n = 24 Partial result: n = 13 |
Baseline Mean morphine oral equivalent dose: 256 mg Post-intervention (post-op) Post-op: mean morphine oral equivalent dose: 254 mg, P = .11 1 month: 217 mg |
Baseline Ambulation was prohibited due to fracture risk or impossible due to pain (n = 22) Post-intervention Of the 22 unable to ambulate, 16 were able to resume walking |
NR |
| Hierholzer et al, 2003158 Germany |
5 patients VP for 5 lesions in pelvic and sacral metastases |
Score 0 (no pain) to 6 (maximum pain) Baseline 6.0 (all patients) Post-intervention (24 hours) 0.5 (0–1.0) |
Baseline NR Post-intervention No longer required any pain medication |
NR | NR |
| Hoffman et al, 2008151 Germany |
22 patients VP and RFA for 28 lesions in the thoracic and lumbar spine, sacrum, pelvis, acetabulum, femur and tibia |
Baseline 8.5 Post-intervention 24 hours: 5.5, P < .01 3 months: 3.5, P < .01 |
Baseline NR Post-intervention Reduction in analgesic use or switch to weaker analgesics (non-opioids from opioids): n = 15 Analgesics remained the same: n = 5 Increase in medication or stronger medication (due to tumour progression elsewhere): n = 2 |
NR | NR |
| Lane et al, 2011152 Canada (earlier Munk et al, 2009159) |
36 patients 53 lesions; RFA (Cool-tip or Radiotherapeutics) and VP for 34 vertebrae, 14 acetabulae, 3 sacra, 1 pubic symphysis, 1 humerus |
Baseline 7.2 ± 1.7 (3.0–9.0) Post-intervention (24 hours) 3.4 ± 1.7 (0–7.0), P < .01 |
NR | NR | NR |
| Sun et al, 2012155 China |
7 patients VP for 14 VB levels: 2 T, 5 L, 7 S |
Baseline 8.6 (8.0–10) Post-intervention (1 month) 3.3 (2.0–5.0) Pain relief (1 month)c Good (VAS 0–3): n = 5 Partial (VAS 4–6): n = 2 Insufficient or none (VAS 7–10): n = 0 |
NR | NR | NR |
| Wang et al, 201249 China |
92 patients VP for 283 VB levels; lesions in pelvis, ilium, and femur |
Baseline 6.1 ± 1.4 Post-intervention 24 hours: 3.5 ± 1.2 1 month: 3.3 ± 1.2 3 months: 2.9 ± 1.5 At 3 months, 82% reported pain reduction of at least 50%; 8% reported less than 25% pain reduction |
NR | Mobility score change, pre-op to 24 hours to 1 month to 3 months, n of patients 0 (no limitation): n = 33 to 36 to 47 to 48 1 (limitation but without the need for orthopedic aids): n = 24 to 29 to 36 to 34 2 (limitation requiring orthopedic aids): n = 23 to 20 to 7 to 7 3 (bedridden) n = 12 to 7 to 2 to 1 Change from pre-op to 24 hours (P > .05), to 1 month (P < .05) and to 3 months (P < .05) |
KPS, mean ± SD Baseline 69 ± 5.5 Post-intervention 24 hours: 75 ± 5.4 1 month: 77 ± 5.8 3 months: 80 ± 5.8, P < .05 HHS, mean ± SD Baseline 35.8 ± 5.5 Post-intervention 24 hours: 41.3 ± 5.7 1 month: 70.5 ± 5.2 3 months: 80.9 ± 6.1, P < .05 |
| Wee et al, 2008156 United Kingdom |
2 patients VP at sacral ala |
Baseline Patient 1: 10.0 Patient 2: 7.0 Post-intervention (24 hours) Patient 1: 3.0 Patient 2: 2.0 |
Baseline Patient 1: hospitalized for pain control Patient 2: high opioid doses Post-intervention NR |
Baseline Patient 1: hospitalized, confined to bed Patent 2: confined to a wheelchair Post-intervention Patient 1: immediately able to sit up post-operatively and gradually mobilizing Patient 2: independently mobile |
NR |
| Kyphoplasty for Sacral Vertebral Compression Fractures | |||||
| No studies found | |||||
Abbreviations: HHS, Harris hip score; KPS, Karnofsky Performance Score; L, lumbar; NR, not reported; PRT, palliative radiotherapy; RFA, radiofrequency ablation; S, sacral; SD, standard deviation; T, thoracic; VAS, visual analogue scale; VB, vertebral body; VP, vertebroplasty.
a
Unless otherwise indicated.