Unilateral percutaneous vertebroplasty for osteoporotic lumbar compression fractures: a comparative study between transverse process root-pedicle approach and conventional transpedicular approach

Abstract

Purpose Percutaneous vertebroplasty (PVP) is a routine operation for the treatment of osteoporotic lumbar compression fractures (OLCFs). As is well known, unilateral puncture is a common method. However, with the conventional transpedicular approach (CTPA), the cement may be asymmetrically dispersed, so some surgeons use the transverse process root-pedicle approach (TPRPA). The objective of this study was to compare the clinical results and bone cement distribution of PVP for OLCF with unilateral TPRPA and CTPA to identify the advantages and disadvantages of the two surgical options. Patients and methods From January 2016 to June 2019, seventy-two elderly patients who underwent unilateral PVP for single-level OLCF were retrospectively reviewed. Operation time, injection amount and type of bone cement distribution, and bone cement leakage and surgical complications were recorded. The visual analog scale (VAS) scores and Oswestry disability index (ODI) scores were used to evaluate the clinical results. All patients were followed up for more than 12 months, and the assessment was based primarily on clinical and radiological outcomes. Results There were significant differences in the surgical time and the volume and the type of bone cement distribution and the lost of operative vertebra height between the two groups. However, there was no significant difference in bone cement leakage. Moreover, there were no significant differences in VAS and ODI between the two groups at 2 days and 12 months after the operation. Conclusions Unilateral TPRPA and CTPA are practical and feasible methods in PVP for the treatment of OLCF, and they have similar clinical effects. However, TPRPA has the advantages of a better distribution of bone cement and a shorter operation time and a better maintenance effect of injured vertebra height, without increasing the rate of bone cement leakage.

Comparison of different approaches of percutaneous vertebroplasty in the treatment of osteoporotic spinal compression fractures and analysis of influencing factors of re-fracture

“…Unilateral PVP was associated with shorter operation time, and the height of anterior edge of vertebral body one week after operation was higher than that of Bilateral-group patients. Our results are in agreement with the study of Zhang et al 12 that indicated that the operation risk of unilateral PVP approach is smaller than that of bilateral PVP, and speculated that the operation time and X-ray irradiation time of bilateral approach are longer. As cement leakage is one of the most frequent complications of PVP, the intraoperative injection of bone cement on one side may increase the possibility of leakage on the other side, thus potentially increasing the risk, associated with the bilateral approach.…”

Biomechanical Analysis of Different Internal Fixation Combined with Different Bone Grafting for Unstable Thoracolumbar Fractures in the Elderly

“…Finite element analysis is an emerging biomechanical research method, which divides the target structure that is difficult to analyze into a finite number of unit aggregates, and it is used to accurately simulate the structure of the spine and internal fixation. By applying different loads, the biomechanical responses of the spine and internal fixation were obtained qualitatively and quantitatively, and targeted prevention methods were proposed to guide the surgical design [ 15 – 18 ].…”

Therapeutic Efficacy and Safety of Percutaneous Curved Vertebroplasty in Osteoporotic Vertebral Compression Fractures: A Systematic Review and Meta‐Analysis

“…Cement leakage could be a serious complication, 20 correlated with the amount of bone cement injection, the pressure of bone cement perfusion, and rupture of perivertebral cortex 51–53 . In the conventional unilateral approach, the needle needs to be excessively introverted to inject cement into the contralateral side of the vertebral body, which may lead to impairment of the pedicle inner cortical bone and paravertebral nerve injury 54 . Additionally, unilateral puncture is demanding at the thoracic level, while bilateral approaches may contribute to cement distribution and reduce the rate of epidural cement leakage 55 .…”