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

Unilaterally extrapedicular versus transpedicular kyphoplasty in treating osteoporotic lumbar fractures: a randomized controlled study

BACKGROUND

The unilaterally extrapedicular approach is adopted increasingly to perform balloon kyphoplasty in treating osteoporotic lumbar fractures, which is intended to improve radiological and clinical efficacy. We compared the efficacy and safety of this method with a unilaterally transpedicular approach.

METHODS

We conducted a single-center, randomized controlled trial enrolling participants with a one-level osteoporotic lumbar fracture in less than 1 month. Patients were randomly assigned to undergo kyphoplasty via either a unilaterally extrapedicular approach (treatment group) or a unilaterally transpedicular approach (control group). The primary outcome was the difference in change from baseline to 1 month in visual analog scale (VAS) scores between the two groups. Secondary outcome measures included vertebral height ratio, operation time, fluoroscopic times, hemoglobin loss, and cement leakage between groups. Data were analyzed by intention to treat principle.

RESULTS

A total of 80 participants were assigned to the treatment group (n = 40) and control group (n = 40), with three and two patients lost to follow-up during 12 months in the two groups, respectively. At 1 month postoperatively, the treatment group showed a greater reduction in VAS score from baseline, compared with the control group (mean difference between groups = 0.63, 95%CI 0.19-1.06). There were no significant between-group differences in restoration in anterior, middle, and posterior vertebral body (P > 0.05). No significant differences were found in the rate of cement leakage and perioperative hemoglobin loss (P > 0.05).

CONCLUSION

Compared with balloon kyphoplasty via the unilaterally transpedicular approach in treating lumbar OVCFs, the unilaterally extrapedicular approach appears to be promising in achieving effective pain relief, adequate cement infusion, short operation time, less fluoroscopy exposure, and comparable risk of cement leakage and vessel injury. It is an alternative approach for lumbar OVCFs treated with kyphoplasty.

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

This systematic review and meta-analysis is aimed to provide higher quality evidence regarding the efficacy and safety between PCVP and PVP/KP in OVCFs. We searched the Cochrane Library, PubMed, Web of Science, and Embase databases for all randomized controlled trials (RCTs) and observational studies (cohort or case-control studies) that compare PCVP to PVP/KP for OVCFs. The Cochrane Collaboration's Risk of Bias Tool and Newcastle-Ottawa Scale (NOS) were used to evaluate the quality of the RCTs and non-RCTs, respectively. Meta-analysis was performed using RevMan 5.4 software. A total of seven articles consisting of 562 patients with 593 diseased vertebral bodies were included. Statistically significant differences were found in the postoperative visual analog scale (VAS) at 1 day (MD = -0.11; 95% CI: [-0.21 to -0.01], p = 0.03), but not at 3 months (MD = -0.21; 95% CI: [-0.41-0.00], p = 0.05) or 6 months (MD = 0.03; 95% CI: [-0.13-0.20], p = 0.70). There was no statistically significant difference in postoperative Oswestry disability index (ODI) at 1 day (MD = -0.28; 95% CI: [-0.62-0.05], p = 0.10), 3 months (MD = -1.52; 95% CI: [-3.11-0.07], p = 0.06), or 6 months (MD = 0.18; 95% CI: [-0.13-0.48], p = 0.25). Additionally, there were no statistically significant differences in Cobb angle (MD = 0.30; 95% CI: [-1.69-2.30], p = 0.77) or anterior vertebral body height (SMD = -0.01; 95% CI: [-0.26-0.23], p = 0.92) after surgery. Statistically significant differences were found in surgical time (MD = -8.60; 95% CI: [-13.75 to -3.45], p = 0.001), cement infusion volume (MD = -0.82; 95% CI: [-1.50 to -0.14], P = 0.02), and dose of fluoroscopy (SMD = -1.22; 95% CI: [-1.84 to -0.60], p = 0.0001) between curved and noncurved techniques, especially compared to bilateral PVP. Moreover, cement leakage showed statistically significant difference (OR = 0.40; 95% CI: [0.27-0.60], p < 0.0001). Compared with PVP/KP, PCVP is superior for pain relief at short-term follow-up. Additionally, PCVP has the advantages of significantly lower surgical time, radiation exposure, bone cement infusion volume, and cement leakage incidence compared to bilateral PVP, while no statistically significant difference is found when compared with unilateral PVP or PKP. In terms of quality of life and radiologic outcomes, the effects of PCVP and PVP/KP are not significantly different. Overall, this meta-analysis reveals that PCVP was an effective and safe therapy for patients with OVCFs.

Multilevel unilateral versus bilateral pedicular percutaneous vertebroplasty for osteoporotic vertebral compression fractures

Study design

Retrospective study.

Objective

Controversy exists over the need for unilateral vs. bilateral pedicular percutaneous vertebroplasty (PVP) for patients with osteoporotic vertebral compression fractures (OVCFs). Clinical research is scarce comparing two approaches for multi-level PVP. This study aimed at evaluating the clinical and radiographic outcomes of multi-level PVP using two approaches for OVCFs.

Methods

Seventy-eight patients with OVCFs undergoing multi-level PVP were enrolled including 36 patients undergoing unilateral PVP and 42 undergoing bilateral PVP. The clinical and radiological assessments including the Visual Analogue Scale (VAS), sagittal and coronal segmental Cobb, vertebral compression ratio (VCR), and vertebral sides ratio (VSR) were evaluated preoperatively and postoperatively.

Results

All patients achieved a minimum 2-year follow-up. A total of 164 fractured vertebrae were enrolled. Regarding clinical efficacy, the VAS score improved in both groups after surgery, but the two groups did not differ significantly. The changes tendency in Sagittal Segmental Cobb, VSR, and VCR were similar postoperatively, and no statistically significant difference between groups. As for the Coronal Segmental Cobb angle, patients in unilateral and bilateral groups were shown to have 5.0° ± 4.0° and 2.6° ± 2.2° degrees loss of correction at a minimum 2-years follow-up duration, respectively. The loss of correction in the Coronal Segmental Cobb of unilateral group was significantly greater than that of bilateral group.

Conclusion

Both multi-level unilateral and bilateral pedicular PVP achieved significant pain reduction and vertebral height restoration. Moreover, the bilateral PVP has shown advantages in stabilizing Coronal Cobb angle in patients with OVCFs.

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

This study introduced a novel point "O" puncture approach for percutaneous kyphoplasty (PKP) in patients with L4 or L5 osteoporotic vertebral compression fracture (OVCF) and evaluated its clinical and radiographic outcomes. Between September 2019 and December 2020, we compared the clinical and radiographic outcomes in 31 cases (36 vertebrae) using the "O" entry point PKP intervention (O-PKP) and 31 cases (37 vertebrae) using transverse the process-pedicle approach PKP intervention (T-PKP). No serious postoperative complications were observed in any of the participants. Only two T-PKP patients experienced intervertebral disc space leakage. Compared with the T-PKP patients, the O-PKP patients showed shorter operative time and fluoroscopy times (P < 0.05), comparable blood loss and cement volume (P > 0.05), improved VAS and ODI scores at the final follow-up (P < 0.05), better increases in the vertebral compression ratio (P < 0.05), comparable Cobb angle (P > 0.05), comparable anteroposterior bone cement distribution, enhanced bilateral bone cement distribution (P < 0.05), and larger sagittal and transverse angles (P < 0.05). Herein, O-PKP was indicated for patients with L4 or L5 OVCF. This puncture approach showed significant advantages over T-PKP not only in terms of pain relief, surgery and fluoroscopy times but also in the puncture angle, vertebral reconstruction, and symmetrical cement distribution.

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

This research was developed to accurately evaluate the unstable fractures of thoracolumbar before and after surgery and discuss the treatment timing and methods. Three-dimensional (3D) finite element method was adopted to construct the T₁₂-L₅ segment model of human body. The efficiency of percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP), two commonly used internal fixation procedures, was retrospectively compared. A total of 150 patients with chest fracture who received PKP or PVP surgery in our hospital, and 104 patients with the same symptoms who received conservative treatment were collected and randomly rolled into PVP group (75 cases), PKP group (75 cases), and control group (104 cases). Visual analog scale (VAS) score and Oswestry disability index (ODI) of patients were collected before and after surgery and 2, 12, and 24 months after surgery. Then, the anterior and central height of the patient's cone and the kyphosis angle were calculated by X-ray. Lumbar minimally invasive fusion system and lumbar pedicle screw rod system were established by computer-aided design (CAD), and the biomechanical characteristics were analyzed. The results showed that there was no substantial difference in VAS score and ODI score between PKP and PVP (P > 0.05), but they were higher than those of the control group (P < 0.05). The anterior edge and middle height of vertebra in the two groups were higher than those in control group (P < 0.05), and the increase in PKP group was more substantial (P < 0.05). The kyphosis of the two groups was smaller than that of the control group (P < 0.05), and the decrease of the kyphosis of the PKP group was more substantial (P < 0.05). In summary, the thoracolumbar segment model established by 3D finite element method was an effective model, and it was verified on patients that both PKP and PVP could achieve relatively satisfactory efficacy. The implantation of the new internal fixation system had no obvious effect on the lumbar movement. This work provided a novel idea and method for the treatment of senile thoracolumbar unstable fracture, as well as experimental data of biomechanics for the operation of senile unstable fracture.