Efficacy and safety of unilateral and bilateral percutaneous balloon kyphoplasty for AOspineA3/A4 osteoporotic thoracolumbar burst fractures

Abstract

To retrospectively evaluate the efficacy and safety of unilateral and bilateral percutaneous balloon kyphoplasty (PKP) in the treatment of osteoporotic thoracolumbar burst fractures. Retrospectively collected clinical data of 138 patients with osteoporotic thoracolumbar burst fractures who underwent unilateral (n = 70) and bilateral (n = 68) PKP in our hospital from March 2015 to December 2018. The general conditions, operation time, radiation exposure time, intraoperative blood loss, bone cement dosage, hospitalization expenses, and complications were collected from the two groups. Visual analog scale (VAS) values, Cobb's angle changes, average vertebral height changes, and Oswestry Dysfunction Index (ODI) values before treatment, 1 month, and 6 months after treatment were collected. There was no significant difference in gender (male: 28 vs 22; female 42 vs 46) and age (70.25 ± 7.10 vs 69.82 ± 8.20, P > .05) distribution between the two groups. The VAS score (7.38 ± 1.34 vs 2.52 ± 0.99, P < .05), ODI (77.24 ± 6.98 vs 23.11 ± 3.54, P < .05), vertebral mean height (16.71 ± 2.18 vs 17.05 ± 1.94, P < .05) and Cobb's angle (20.26 ± 3.21 vs 11.58 ± 3.20, P < .05) of the two groups were significantly improved after operation, but there was no significant difference between the two groups ( P > .05). There was no significant difference in the rate of cement leakage (10.29% vs 11.42%, P > .05), incision swelling (30.88% vs 19.71%, P > .05) and incidence of adjacent vertebrae (4.41% vs 5.71%, P > .05) between the two groups. Compared with bilateral PKP group, operation time (50.88 ± 7.38 vs 62.18 ± 8.01), intraoperative blood loss (14.54 ± 3.16 vs 22.03 ± 5.92), radiation exposure time (23.74 ± 3.41 vs 15.22 ± 3.70), bone cement dosage (4.36 ± 0.81 vs 5.16 ± 0.77) and hospitalization costs (2.38 ± 0.08 vs 2.74 ± 0.07) were significantly lower in the unilateral PKP group ( P < .05). Bilateral PKP and unilateral PKP have the same efficacy and safety in the treatment of osteoporotic thoracolumbar burst fractures. However, the unilateral PKP has the characteristics of short operation time, small trauma, low cost and short radiation exposure time, and has clinical application value.

Finite element analysis of dynamic changes in spinal mechanics of osteoporotic lumbar fracture

“…This method can not only restore vertebral body height and correct vertebral kyphosis deformity, but also reduce pain, the leakage rate of bone cement, and complications, such as nerve injury and pulmonary embolism [ 24 ]. PKP has been reported to be clinically valuable for the treatment of thoracolumbar fracture because of its short operation time, less trauma, low cost, short radiotherapy time, and so on [ 25 ]. This study revealed that there was no significant difference in the peak stress and displacement of the model between PKP and PVP treatment.…”

Could lateral decubitus position improve the cement distribution of unilateral percutaneous kyphoplasty in patients with osteoporotic vertebral compression fracture?

“…Unilateral and bilateral PKP, as main approaches of this surgery, has been both proved to have an obviously positive effect on OVCF, while unilateral approach seemed to be easy to operate. Recent comparative studies [14,15] found that unilateral PKP are safe and effective for OVCF patients as bilateral PKP, but need less radiation dose, less operation time and fewer cement volume. And several meta-analyses [16][17][18] proposed the similar viewpoints and suggested that unilateral PKP appeared to be superior to bilateral PKP in the treatment of OVCFs.…”

“…It has been proved by many researchers [9][10][11][12] that this surgery can relieve pain symptom, reinstate the vertebral height and restore the spinal alignment immediately, which seal off the gap of the above-mentioned treatment. And several studies [13][14][15] further proved that unilateral PKP has similar effects on pain relief and vertebral height restoration as bilateral PKP, but with shorter surgical time and less blood loss which suggests that this surgery was better for OVCF patients. Nonetheless, it was commonly found in clinical practice that cement was prone to be distributed around injection point and unable to reach the contralateral side of vertebrae, resulting in a symmetrical stress distribution.…”

Treatment of Osteoporotic Thoracolumbar Burst Fractures by Bilateral Pedicle Vertebroplasty Combined With Postural Reduction

“…Conservative treatment requires long-time bed rest and braking, which increases the risk of accumulation pneumonia, urinary system infection, lower extremity deep venous thrombosis and bedsore. In addition, some patients have fracture nonunion and further collapse of vertebral body, resulting in kyphosis, and develop into chronic pain, even delayed nerve damage, which seriously affects the quality of life of elderly patients [3], and may even endanger their lives due to complications. However, for the majority of AO Spine type A3/A4 elderly osteoporotic thoracolumbar burst fractures are often complicated with basic diseases such as chronic bronchitis, emphysema, coronary atherosclerotic heart disease, or severe trauma and combined injury, and cannot tolerate open surgery under general anesthesia.…”

“…The surgical operation for burst fractures without neurological de cit remains controversial. For elderly vertebral burst fractures, it is considered as a contraindication because of the concomitant posterior wall rupture and encroachment of the fracture fragment into the spinal canal [3,4].Some scholars [3][4][5][6][7][8] believe that the PVP given to elderly patients with OTLBF has a signi cant effect on the pain level of the patients, and it has a signi cant effect on the correction of kyphosis and the restoration of vertebral height. After considering the patents general condition, we performed the percutaneous vertebroplasty combined with reduction for treating OTLBF,reduce the risk of surgery and xed time to achieve satisfactory results.…”