Single-stage Vertebroplasty for Four or More Levels in Patients with Osteoporotic Compression Fractures - Safe and Effective or a High-risk Practice?

Introduction: The single-stage multi-level vertebroplasty is still debatable. We evaluated the safety and effectiveness of single-stage vertebroplasty of four or more levels.

Methods: The study was carried out at the Clinic of Neurosurgery, University Hospital "St. Marina", Varna, Bulgaria for a period of 3 years (2020-2023). The clinical material included 39 patients (7m/32f) with osteoporotic vertebral compression fractures and ASIA scale grade E treated by vertebroplasty (167 vertebrae in total). VAS was applied to evaluate clinical outcomes, as well as CT scan and X-ray to evaluate vertebral height correction and kyphotic deformities. All patients were followed-up for a period of 2 months and examined for the presence of new fractures, morbidity or mortality.

Results: The average operating time was 55 minutes. Excellent clinical results, according to VAS, were reported with pre-operative values of 6.62 pts. and post-operative values of 2.14 pts. The average value of vertebral height restoration and kyphotic deformity correction was about 4-5 degrees. Cement leakage into the spinal canal, large vessels, or intervertebral disc spaces occurred in approximately 50% of the cases. However, no procedure-related morbidity or mortality was documented, nor was open revision surgery required in the series. In 7 patients, a new fracture caused a repeat vertebroplasty.

Conclusion : In patients with osteoporotic compression fractures, the single-stage vertebroplasty on four or more levels is a safe and effective solution, resulting in pain syndrome reduction and returning to a normal lifestyle. Unfortunately, it is associated with minimal vertebral height restoration and kyphotic deformity correction. The high percentage of cement leakage during multi-segmental vertebroplasty is not clinically significant and does not lead to a new surgical intervention.