European Radiology

, Volume 28, Issue 7, pp 2735–2742 | Cite as

What are the predictors of clinical success after percutaneous vertebroplasty for osteoporotic vertebral fractures?

  • Elsa Denoix
  • Flore Viry
  • Agnes Ostertag
  • Caroline Parlier-Cuau
  • Jean-Denis Laredo
  • Martine Cohen-Solal
  • Valérie Bousson
  • Thomas Funck-Brentano



Osteoporotic vertebral fractures are responsible for acute pain and disability that may persist for more than 2 months. We wanted to identify predicting factors for mid-term outcome after vertebroplasty.


We included consecutive patients who underwent vertebroplasty for fragility fractures with persistent and intense pain between January 2014–June 2016. Outcome was assessed by an independent clinician after 1 month using a standardized questionnaire. Patients were classified as having either a favorable or a poor outcome. Presence of an intravertebral cleft and bone oedema mean signal intensity was assessed by an independent radiologist blinded to the clinical data. Pre-intervention clinical or radiological factors were analysed as predictors for outcome.


In the 78 included patients (females 71%, age 75 ± 8.3 years), 61.5% had a favourable outcome. When vertebroplasty was performed within 2 months after fracture, the outcome was favourable in 19 patients (39.6%) and poor in five (16.7%; estimate for favourable outcome: OR = 4.1, 95% CI 1.2–13.8, p = 0.021). Absence of intravertebral cleft on pre-intervention imaging was also a predictor of favourable outcome (OR = 3.7, 95% CI 1.2–11.8, p = 0.024). On pre-intervention MRI, vertebral body oedema intensity signal did not influence the outcome.


In patients with persistent and intense pain after an osteoporotic vertebral fracture, early intervention and absence of intravertebral cleft were predictors of favourable outcome at 1 month after vertebroplasty.

Key Points

• Performing vertebroplasty within 2 months following a fragility fracture increases success rate.

• Presence of an intravertebral cleft at baseline is a predictor of poor mid-term outcome.

• A pre-intervention MRI should be performed to ascertain the indication of vertebroplasty.


Vertebroplasty Fractures, compression Osteoporotic fractures Treatment outcome Pain measurement 



Confidence interval




Odds ratio


Standard deviation





We are grateful to Pr. Philippe Orcel and Pr. Pascal Richette for their advice and to Dr. Bassam Hamze who performed part of the interventions.


The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Dr Thomas Funck-Brentano.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Dr. Agnès Ostertag has significant statistical expertise.

Informed consent

Written informed consent was obtained from all patients in this study.

Ethical approval

Institutional Review Board approval was not required because it was an observational study to evaluate a standard-care procedure, and not an intervention study.


• Retrospective with prospective outcome assessment

• Observational

• Performed at one institution

Supplementary material

330_2017_5274_MOESM1_ESM.docx (18 kb)
ESM 1 (DOCX 17 kb)


  1. 1.
    O’Neill TW, Felsenberg D, Varlow J et al (1996) The prevalence of vertebral deformity in European men and women: the European Vertebral Osteoporosis Study. J Bone Miner Res 11:1010–1018CrossRefPubMedGoogle Scholar
  2. 2.
    Cauley JA, Hochberg MC, Lui L-Y et al (2007) Long-term risk of incident vertebral fractures. JAMA 298:2761–2767CrossRefPubMedGoogle Scholar
  3. 3.
    Bliuc D, Nguyen ND, Milch VE et al (2009) Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA 301:513–521CrossRefPubMedGoogle Scholar
  4. 4.
    Johnell O, Gullberg B, Kanis JA (1997) The hospital burden of vertebral fracture in Europe: a study of national register sources. Osteoporos Int 7:138–141CrossRefPubMedGoogle Scholar
  5. 5.
    Lyritis GP, Mayasis B, Tsakalakos N et al (1989) The natural history of the osteoporotic vertebral fracture. Clin Rheumatol 8:66–69CrossRefPubMedGoogle Scholar
  6. 6.
    Ensrud KE, Schousboe JT (2011) Vertebral Fractures. N Engl J Med 364:1634–1642CrossRefPubMedGoogle Scholar
  7. 7.
    Suzuki N, Ogikubo O, Hansson T (2008) The prognosis for pain, disability, activities of daily living and quality of life after an acute osteoporotic vertebral body fracture: its relation to fracture level, type of fracture and grade of fracture deformation. Eur Spine J 18:77–88CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Ettinger B, Black DM, Nevitt MC et al (1992) Contribution of vertebral deformities to chronic back pain and disability. J Bone Miner Res 7:449–456CrossRefPubMedGoogle Scholar
  9. 9.
    Hoshino M, Nakamura H, Terai H et al (2009) Factors affecting neurological deficits and intractable back pain in patients with insufficient bone union following osteoporotic vertebral fracture. Eur Spine J 18:1279–1286CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Hasegawa K, Homma T, Uchiyama S, Takahashi H (1998) Vertebral pseudarthrosis in the osteoporotic spine. Spine 23:2201–2206CrossRefPubMedGoogle Scholar
  11. 11.
    Kawaguchi S, Horigome K, Yajima H et al (2010) Symptomatic relevance of intravertebral cleft in patients with osteoporotic vertebral fracture. J Neurosurg Spine 13:267–275CrossRefPubMedGoogle Scholar
  12. 12.
    Bonnard E, Foti P, Kastler A, Amoretti N (2017) Percutaneous vertebroplasty under local anaesthesia: feasibility regarding patients’ experience. Eur Radiol 27:1512–1516CrossRefPubMedGoogle Scholar
  13. 13.
    Mathis JM, Barr JD, Belkoff SM et al (2001) Percutaneous vertebroplasty: a developing standard of care for vertebral compression fractures. Am J Neuroradiol 22:373–381PubMedGoogle Scholar
  14. 14.
    Diamond TH, Champion B, Clark WA (2003) Management of acute osteoporotic vertebral fractures: a nonrandomized trial comparing percutaneous vertebroplasty with conservative therapy. Am J Med 114:257–265CrossRefPubMedGoogle Scholar
  15. 15.
    Do HM, Kim BS, Marcellus ML et al (2005) Prospective analysis of clinical outcomes after percutaneous vertebroplasty for painful osteoporotic vertebral body fractures. AJNR Am J Neuroradiol 26:1623–1628PubMedGoogle Scholar
  16. 16.
    Voormolen MHJ, Mali WPTM, Lohle PNM et al (2007) Percutaneous vertebroplasty compared with optimal pain medication treatment: short-term clinical outcome of patients with subacute or chronic painful osteoporotic vertebral compression fractures. The VERTOS study. AJNR Am J Neuroradiol 28:555–560PubMedGoogle Scholar
  17. 17.
    Clarençon F, Fahed R, Gabrieli J et al (2016) Safety and Clinical Effectiveness of Percutaneous Vertebroplasty in the Elderly (≥80 years). Eur Radiol 26:2352–2358CrossRefPubMedGoogle Scholar
  18. 18.
    Kallmes DF, Comstock BA, Heagerty PJ et al (2009) A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med 361:569–579CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Buchbinder R, Osborne RH, Ebeling PR et al (2009) A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med 361:557–568CrossRefPubMedGoogle Scholar
  20. 20.
    Klazen CA, Lohle PN, de Vries J et al (2010) Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial. Lancet 376:1085–1092CrossRefPubMedGoogle Scholar
  21. 21.
    Farrokhi MR, Alibai E, Maghami Z (2011) Randomized controlled trial of percutaneous vertebroplasty versus optimal medical management for the relief of pain and disability in acute osteoporotic vertebral compression fractures. J Neurosurg Spine 14:561–569CrossRefPubMedGoogle Scholar
  22. 22.
    Clark W, Bird P, Gonski P et al (2016) Safety and efficacy of vertebroplasty for acute painful osteoporotic fractures (VAPOUR): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet 388:1408–1416CrossRefPubMedGoogle Scholar
  23. 23.
    Malghem J, Maldague B, Labaisse MA et al (1993) Intravertebral vacuum cleft: changes in content after supine positioning. Radiology 187:483–487CrossRefPubMedGoogle Scholar
  24. 24.
    Syed MI, Shaikh A, Cortoss Study Group (2012) Does age of fracture affect the outcome of vertebroplasty? Results from data from a prospective multicenter FDA IDE study. J Vasc Interv Radiol 23:1416–1422CrossRefPubMedGoogle Scholar
  25. 25.
    Nieuwenhuijse MJ, van Rijswijk CSP, van Erkel AR, Dijkstra SPD (2012) The Intravertebral Cleft in Painful Long-Standing Osteoporotic Vertebral Compression Fractures Treated With Percutaneous Vertebroplasty: Diagnostic Assessment and Clinical Significance. Spine 37:974–981CrossRefPubMedGoogle Scholar
  26. 26.
    Wiggins MC, Sehizadeh M, Pilgram TK, Gilula LA (2007) Importance of Intravertebral Fracture Clefts in Vertebroplasty Outcome. Am J Roentgenol 188:634–640CrossRefGoogle Scholar
  27. 27.
    Lane JI, Maus TP, Wald JT et al (2002) Intravertebral clefts opacified during vertebroplasty: pathogenesis, technical implications, and prognostic significance. Am J Neuroradiol 23:1642–1646PubMedGoogle Scholar
  28. 28.
    Fang X, Yu F, Fu S, Song H (2015) Intravertebral clefts in osteoporotic compression fractures of the spine: incidence, characteristics, and therapeutic efficacy. Int J Clin Exp Med 8:16960PubMedPubMedCentralGoogle Scholar
  29. 29.
    Tsujio T, Nakamura H, Terai H et al (2011) Characteristic radiographic or magnetic resonance images of fresh osteoporotic vertebral fractures predicting potential risk for nonunion: a prospective multicenter study. Spine 36:1229–1235CrossRefPubMedGoogle Scholar
  30. 30.
    Kanis JA, McCloskey EV, Johansson H et al (2013) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 24:23–57CrossRefPubMedGoogle Scholar
  31. 31.
    Cosman F, de Beur SJ, LeBoff MS et al (2014) Clinician’s Guide to Prevention and Treatment of Osteoporosis. Osteoporos Int 25:2359–2381CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of RheumatologyAP-HP, Lariboisière Teaching HospitalParisFrance
  2. 2.Department of Musculoskeletal RadiologyAP-HP, Lariboisière Teaching HospitalParisFrance
  3. 3.BIOSCAR UMRS 1132, Université Paris Diderot, Sorbonne Paris Cité, INSERMParisFrance
  4. 4.B2OA UMR 7052, Université Paris Diderot, Sorbonne Paris Cité, CNRSParisFrance

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