Intrasomatic injection of corticosteroid followed by vertebroplasty increases early pain relief rather than vertebroplasty alone in vertebral bone neoplasms: preliminary experience

PURPOSE:In this prospective multicenter study, we evaluate the effectiveness of corticosteroid plus vertebroplasty rather than vertebroplasty alone in the analgesic treatment of single-level vertebral neoplasms or pathological fractures.MATERIALS AND METHODS:From January 2009 to February 2011, we prospectively enrolled 20 consecutive patients (11 women, nine men; age range 46-78 years; mean age 65.1 years) with single-level vertebral neoplasm or pathological fractures totally or partially refractory to analgesic treatment, with indication to vertebroplasty. Institutional review board approval and informed consent were obtained. The inclusion criteria for the study were the presence of a single-level pathological fracture not extended to the posterior wall or symptomatic localization of primary or secondary neoplasms, visual analogue score (VAS) ≥5, and life expectancy more than 3 months. Exclusion criteria where all contraindications either to corticosteroid injection included allergy (local sepsis, bacteremia, allergy) or vertebroplasty included coagulopathy, etc. The population was randomly divided into two groups: in group A, patients underwent intrasomatic injections of 4 mg/ml of dexamethasone phosphate followed by a cement injection; patients in group B underwent standard vertebroplasty. VAS score was evaluated and compared between both groups of patients at 6 h, 24 h, 48 h, 7 days, 30 days, and 3 months after the intervention plus last available follow-up. Statistical analyses were performed by application of the t test.RESULTS:Technical success was achieved in all cases. In group A, we treated six male and six female patients (age range 46-73 years, average 60.2 years). Pre-intervention VAS in group A ranged between 7 and 10 points, average 8 points. In group B, we treated three male and five female patients (age range 52-78 years, average 67.3 years). Pre-intervention VAS score in group B ranged between 7 and 9 points, with an average 8 points. Patients in group A in respect to patients in group B had a higher reduction in VAS, with a difference of 25.4% (VAS reduction average 5.5 versus 4.1) at 6 h post-intervention, 24.5% (VAS average 5.7 versus 4.3) at 24 h, 25% (VAS average 6 versus 4.5) at 48 h, 23% (VAS average 6.5 versus 5) at 7 days, 16.4% (VAS average 6.7 versus 5.6) at 30 days, 8.9% (VAS average 6.7 versus 6, .1) at 3 months. The last available follow-up ranged from 3 to 24 months in group A and from 5 to 20 months in group B.CONCLUSIONS:In our preliminary experience, pre-vertebroplasty injection of intrasomatic corticosteroid in comparison to vertebroplasty alone is able to increase the early pain relief of the procedure.