Unipedicular Vertebroplasty for Osteoporotic Compression Fracture Using an Individualized Needle Insertion Angle

Abstract

Unipedicular PVP can be performed safely, provided the operator has a thorough knowledge of the bony landmarks and the anatomy of the pedicle. A unipedicular approach could be considered first using individualized NIA at each vertebral level.

Clinical Outcomes with Hemivertebral Filling during Percutaneous Vertebroplasty

“…Additionally, the authors found that the unaugmented side of a laterally placed injection was not at an increased risk for collapse, as previously thought. 3,16,17 Our study has several limitations. The study was conducted retrospectively; thus, it was subject to bias.…”

Comparison of Unilateral versus Bilateral Kyphoplasty in Multiple Myeloma Patients and the Importance of Preoperative Planning

“…Also interpretation of fluoroscopic images is easier, since the introduction of the second cannula may obscure the field of vision. The majority of the studies in the literature, either biomechanical [7,9,17] or clinical [4,5,6,8,10], support its use and equivalent effectiveness with regard to the bilateral approach, with satisfactory cement filling and coronal alignment. However, few comparative studies have been published up to date; there are 4 studies on osteoporotic fractures [11,12,13,14,21] and 1 on cancer-related fractures [22].…”

“…Whereas the technique is intriguing, we find it complex and difficult to apply in comparison with our method. Another interesting technical note was published by Chang et al [6] in relation to the use of oblique fluoroscopy. The authors challenged the traditional 20° to 30° inclination of the C-arm suggested by others [5] and calculated the individual needle angle from an axial MRI.…”

“…In the lumbar spine, the presence of descending lumbar nerve roots makes this technique more challenging [6]. However, with the approach we describe, in many cases it is feasible, with a more medialized direction starting from the mamillary process and aiming at the middle of the vertebral body, especially in the lower lumbar spine.…”

“…However, the unilateral approach is gaining popularity due to decreased surgical time, radiation exposure, costs and overall complication rate [4,5,6,7,8,9,10,11]. Whereas most authorities feel that both approaches yield similar results, a couple of the existing comparative studies reported the superiority of the bilateral approach in terms of kyphosis reduction [12,13,14], with one group reporting opposite results between the early [12] and late phases [14].…”