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AJNR - American Journal of Neuroradiology

Publication Preview: Published January 15, 2009

American Journal of Neuroradiology 2009;30:496.

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American Journal of Neuroradiology
DOI 10.3174/ajnr.A1416

SPINE

Clinical Outcomes with Hemivertebral Filling during Percutaneous Vertebroplasty

E.M. Knavel, A. Ehteshami Rad, K.R. Thielen and D.F. Kallmes

From the University of Wisconsin School of Medicine and Public Health (E.M.K.), Madison, Wis; and Department of Radiology (A.E.R., K.R.T., D.F.K.), Mayo Clinic, Rochester, Minn.

Please address correspondence to David F. Kallmes, MD, Mayo Clinic, 200 First St SW, Rochester, MN 55905; e-mail: Kallmes.david{at}mayo.edu

BACKGROUND AND PURPOSE: Vertebroplasty has been commonly used for the treatment of vertebral compression fractures. Practitioners usually attempt to maximize filling of the vertebral body with polymethylmethacrylate (PMMA), either by using a bipediculate approach with separate infusions in both hemivertebrae or by using a unipediculate approach with central needle placement that allows bilateral hemivertebral filling. This study serves to investigate the clinical efficacy of a unipediculate approach in which the cement injected does not cross the midline, with resultant "hemivertebroplasty."

MATERIALS AND METHODS: A retrospective review of 917 vertebroplasty procedures was performed. A radiologic review of each vertebroplasty in the data base was performed to extract the vertebroplasties in which there was filling of only 1 side of the hemivertebra, which we term "hemivertebroplasty." Pre- and postoperative evaluations (1-week to 2-year postprocedure) included a Visual Analog Scale (VAS) for pain, the Roland-Morris Disability Questionnaire (RDQ) scores, and information regarding new fractures and retreatment of augmented fractures.

RESULTS: No significant difference was found between the hemivertebroplasty cases and the bilaterally filled vertebroplasty group in reducing VAS or RDQ scores. Moreover, survival analysis showed no significant difference in the risk of incident fracture between groups (hazard ratio = 0.81; 95% confidence interval, 0.33–2.65).

CONCLUSIONS: On the basis of our results, unilateral "hemivertebroplasty" is as effective in reducing pain with activity and at rest and decreasing the RDQ scores as bilateral vertebral filling. Additionally, vertebrae undergoing unilateral filling were at no greater risk of refracture or fracture of adjacent vertebrae than bilaterally filled vertebrae.