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 fracture (OLCF). Because of bilateral puncture takes a long operation time and patients receive more X-ray irradiation, more and more scholars deem that the unilateral approach should be adopted. But, with conventional transpedicular approach (CTPA), the cement may asymmetrically dispersed, so some surgeons use the transverse process root-pedicle approach (TPRPA). The objective of this study is to compare the clinical results and bone cement distribution of PVP for OLCF with unilateral TPRPA and CTPA, determine 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 distribution type of bone cement, and bone cement leakage and surgical complication were recorded. The visual analogue scale (VAS) scores and Oswestry disability index (ODI) scores were used to evaluate the clinical results. All patients were followed up for at more than 12 months and the assessment was based primarily on clinical and radiological outcomes.Results: There were significant difference in the surgical time, the volume and distribution type of bone cement between the two groups. But, there was no statistical 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 operation.Conclusion: Unilateral TPRPA and CTPA are practical and feasible methods in PVP for treatment of OLCF, with similar clinical effects. However, TPRPA has the advantages of fair distribution of bone cement and short operation time, without increasing the rate of bone cement leakage.

Whether the Unilateral Transverse Process-pedicle Approach has Advantages over the Traditional Transpedicle Approach: A Systematic review and Meta-analysis

“…Wang et al [27] reported that the transverse process-pedicle approach group presented with a more lateral entry point, larger puncture inclination angles, and higher success rates than that in the CTPA group. On the basis of reducing the risk of puncture, the unilateral transversal-pedicle approach is the best target site for PVA surgery, and bone cement can be diffused contralaterally, achieving the same satisfactory clinical results as the bilateral pedicle approach [28]. When performing a puncture operation, the puncture needle should exceed the midline of the vertebral body to maximize the uniform distribution of bone cement, so as to restore the height of the vertebral body, correct scoliosis, and reduce the risk of postoperative vertebral instability, bone cement leakage, and re-collapse of the injured vertebral body.…”

A novel puncture approach via point “O” for percutaneous kyphoplasty in patients with L4 or L5 osteoporotic vertebral compression fracture

“…Hence, at the present time, there are multiple unilateral puncture approaches, such as, conventional transpedicular approach (CPA), transverse processpedicle approach (TPA), and extrapedicular approach [6] . These puncture approaches are considered both safe and e cient [7,8] . However, till date, the main spinal segments analyzed in these studies were thoracic and thoracolumbar vertebra, and the sample sizes of the lower lumbar vertebra were relatively small in number.…”