THU0487 An audit of the use of percutaneous vertebroplasty for osteoporotic vertebral fractures in a uk rheumatology clinic
Authors: J. Pinnell, H. Merris, M. Dhillon, K. Chaudhuri
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> University Hospital, Coventry, UK (UHCW), offers percutaneous vertebroplasty (PVP) to patients with painful osteoporotic vertebral fractures. The National Institute for Health and Care Excellence (NICE) Technology Appraisal 279 (TA279) (2013) restricts the use of PVP to patients with severe ongoing pain despite optimal pain management, where the pain corresponds to the level of fracture on examination and imaging.<sup>1</sup> <h3>Objectives</h3> To audit the use of PVP by Rheumatology at UHCW against NICE TA279.<sup>1</sup> To assess the clinical outcomes of PVP for our patients. <h3>Methods</h3> The records of all UHCW Rheumatology patients who received PVP from MD<sup>3</sup> (Interventional Radiologist) between September 2007 and August 2014 were retrospectively assessed against NICE TA279.<sup>1</sup> We defined a 'recent' fracture as occurring 6–12 weeks prior to PVP as this allows time for natural bone healing whilst minimising therapeutic delay.<sup>1</sup> 'Optimal pain management' was defined as analgesia in addition to, or stronger than, paracetamol. <h3>Results</h3> 57 of the 221 PVP performed by MD were for Rheumatology patients. 38 patients were female and 19 were male. They were aged 42–95 years (median 73), and 95% were Caucasian. 26 had taken corticosteroids for more than 6 months. 7 patients received PVP 6–12 weeks after their fracture. 10 patients had PVP within 6 weeks. 39 patients waited 12 weeks or longer due to late patient presentation, slow referral processes, and the time taken to optimise analgesia. 38 (67%) patients received optimal analgesia before PVP. 46 (81%) patients had pain that correlated with the level of vertebral fracture.<sup>1</sup> Following PVP back pain was gone for 9 (16%) patients, improved for 38 (66%), not changed for 4 (7%), and worse for 1 (2%) patient. Complications included leakage of cement locally (57%) or into local veins (5%). 2 patients had pulmonary cement emboli. One presented with breathlessness and the second was found incidentally. Both recovered with conservative therapy. <h3>Conclusions</h3> In line with NICE TA279, most patients had pain at the level of their fracture and received optimal pain management prior to receiving PVP. 10 patients received PVP earlier than our standard of 6 weeks. However, recent randomised trials suggest that PVP may be beneficial in this group.<sup>2</sup> Most (68%) patients received PVP later than 12 weeks but they often found benefit. The VERTOS V trial may help determine the role of PVP for chronic fractures.<sup>3</sup> Introducing an osteoporotic vertebral fracture pathway at UHCW will help ensure appropriate management, timely review and, when necessary, prompt PVP. <h3>References</h3> [1] National Institute for Health and Care Excellence. Percutaneous vertebroplasty and percutaneous balloon kyphoplasty for treating osteoporotic vertebral compression fractures. NICE guideline [TA279] 2013. [2] Clark, et al. Safety and efficacy of vertebroplasty for acute painful osteoporotic fractures (VAPOUR): a multicentre, randomised, double-blind, placebo-controlled trial. The Lancet2016;388(10052):1408–16. [3]. ClinicalTrials.gov [Internet]. National Library of Medicine (US). Identifier NCT01963039, A Trial of Vertebroplasty for Painful Chronic Osteoporotic Vertebral Fractures (Vertos V); 2013 Oct 16. [cited 2018 Jan 29]. Available from: https://clinicaltrials.gov/ct2/show/NCT01963039 <h3>Disclosure of Interest</h3> None declared