Abstract
Objective To introduce a modified transverse process-pedicle puncture technique applied to unilateral extrapedicular percutaneous vertebroplasty (PVP) for the treatment of osteoporotic lumbar vertebral compression fractures. Methods A retrospective study was performed on 91 patients with osteoporotic vertebral compression fractures (OVCFs) who underwent unilateral extrapedicular PVP from June 2016 to September 2018. Lumbar and back pain was assessed through the visual analogue scale (VAS). Function recovery was assessed through the Oswestry disability index (ODI). Radiologic outcomes were assessed mainly on the basis of bone cement distribution and anterior vertebral height. Results A total of 101 fractured vertebrae were successfully treated using the extrapedicular technique without any recognized clinical complications. The postoperative VAS and ODI values were significantly lower than the corresponding preoperative values (P < 0.01). Radiologic outcomes in all fractured vertebrae showed that the diffusion of bone cement could exceed the midline of the vertebral body. There was no significant difference between preoperative and postoperative anterior vertebral heights (P < 0.05). Conclusion The modified transverse process-pedicle approach applied to unilateral extrapedicular percutaneous vertebroplasty is a simple, safe, and effective surgical method.
Highlights
Osteoporotic vertebral compression fractures (OVCFs) are one of the most common complications of osteoporosis in the elderly and often lead to severe back pain, kyphosis, impaired mobility, and reduced quality of life [1,2,3]
Inclusion criteria were as follows: (1) vertebral compression fractures from L1 to L5; (2) less than 50% loss of vertebral height; (3) bone mineral density (BMD) of −2.5 or lower; (4) on magnetic resonance imaging (MRI), the fractured vertebral body showed a hypointense signal on T1-weighted images and hyperintense signal on T2-weighted images; and (5) able to tolerate local infiltration anesthesia and to lie prone or laterally for 30 minutes without serious underlying diseases
Radiologic outcomes in all fractured vertebrae showed that the diffusion of bone cement could exceed the midline of the vertebral body (Figure 3)
Summary
Osteoporotic vertebral compression fractures (OVCFs) are one of the most common complications of osteoporosis in the elderly and often lead to severe back pain, kyphosis, impaired mobility, and reduced quality of life [1,2,3]. Percutaneous vertebroplasty (PVP) is a widely used procedure for the clinical treatment of OVCFs and can obviously relieve pain, reduce bed rest time, and prevent deformity due to collapse of the vertebral body [4,5,6]. Unipedicular PVP has been advocated, reducing the operation and radiation exposure time periods and lowering the risk of cement leakage and complications caused by vertebral pedicle puncture [2, 9, 10]. Due to the large sagittal diameter of the spinal canal, the long pedicle length, and the small angle of the pedicle in the coronal position, it is difficult to achieve proper bilateral diffusion through unilateral pedicle puncture in the treatment of lumbar vertebral compression fractures. We will demonstrate a simple and easy unilateral puncture method for extrapedicular PVP and show that it has the advantages of safety, efficiency, and less pain
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