Bilateral Percutaneous Vertebroplasty Research Articles

Effect of different cement distribution in bilateral and unilateral Percutaneous vertebro plasty on the clinical efficacy of vertebral compression fractures

BackgroundThe ramifications of osteoporotic fractures and their subsequent complications are becoming progressively detrimental for the elderly population. This study evaluates the clinical ramifications of postoperative bone cement distribution in patients with osteoporotic vertebral compression fractures (OVCF) who underwent both bilateral and unilateral Percutaneous Vertebroplasty (PVP).ObjectiveThe research aims to discern the influence of bone cement distribution on the clinical outcomes of both bilateral and unilateral Percutaneous Vertebroplasty. The overarching intention is to foster efficacious preventive and therapeutic strategies to mitigate postoperative vertebral fractures and thereby enhance surgical outcomes.MethodsA comprehensive evaluation was undertaken on 139 patients who received either bilateral or unilateral PVP in our institution between January 2018 and March 2022. These patients were systematically classified into three distinct groups: unilateral PVP (n = 87), bilateral PVP with a connected modality (n = 29), and bilateral PVP with a disconnected modality (n = 23). Several operational metrics were juxtaposed across these cohorts, encapsulating operative duration, aggregate hospital expenses, bone cement administration metrics, VAS (Visual Analogue Scale) scores, ODI (Oswestry Disability Index) scores relative to lumbar discomfort, postoperative vertebral height restitution rates, and the status of the traumatized and adjacent vertebral bodies. Preliminary findings indicated that the VAS scores for the January and December cohorts were considerably reduced compared to the unilateral PVP group (P = 0.015, 0.032). Furthermore, the recurrence of fractures in the affected and adjacent vertebral structures was more pronounced in the unilateral PVP cohort compared to the bilateral PVP cohorts. The duration of the procedure (P = 0.000) and the overall hospitalization expenses for the unilateral PVP group were markedly lesser than for both the connected and disconnected bilateral PVP groups, a difference that was statistically significant (P = 0.015, P = 0.024, respectively). Nevertheless, other parameters, such as the volume of cement infused, incidence of cement spillage, ODI scores for lumbar discomfort, post-surgical vertebral height restitution rate, localized vertebral kyphosis, and the alignment of cement and endplate, did not exhibit significant statistical deviations (P > 0.05).ConclusionIn juxtaposition with unilateral PVP, the employment of bilateral PVP exhibits enhanced long-term prognostic outcomes for patients afflicted with vertebral compression fractures. Notably, bilateral PVP significantly curtails the prevalence of subsequent vertebral injuries. Conversely, the unilateral PVP cohort is distinguished by its abbreviated operational duration, minimal invasiveness, and reduced overall hospitalization expenditures, conferring it with substantial clinical applicability and merit.

Effects of different puncture levels in bilateral percutaneous vertebroplasty on distribution of bone cement and effectiveness of osteoporotic thoracolumbar compression fractures

To investigate the effects of different puncture levels on bone cement distribution and effectiveness in bilateral percutaneous vertebroplasty for osteoporotic thoracolumbar compression fractures. A clinical data of 274 patients with osteoporotic thoracolumbar compression fractures who met the selection criteria between December 2017 and December 2020 was retrospectively analyzed. All patients underwent bilateral percutaneous vertebroplasty. During operation, the final position of the puncture needle tip reached was observed by C-arm X-ray machine. And 118 cases of bilateral puncture needle tips were at the same level (group A); 156 cases of bilateral puncture needle tips were at different levels (group B), of which 87 cases were at the upper 1/3 layer and the lower 1/3 layer respectively (group B1), and 69 cases were at the adjacent levels (group B2). There was no significant difference in gender, age, fracture segment, degree of osteoporosis, disease duration, and preoperative visual analogue scale (VAS) score, and Oswestry disability index (ODI) between groups A and B and among groups A, B1, and B2 ( P>0.05). The operation time, bone cement injection volume, postoperative VAS score, ODI, and bone cement distribution were compared among the groups. All operations were successfully completed without pulmonary embolism, needle tract infection, or nerve compression caused by bone cement leakage. There was no significant difference in operation time and bone cement injection volume between groups A and B or among groups A, B1, and B2 ( P>0.05). All patients were followed up 3-32 months, with an average of 7.8 months. There was no significant difference in follow-up time between groups A and B and among groups A, B1, and B2 ( P>0.05). At 3 days after operation and last follow-up, VAS score and ODI were significantly lower in group B than in group A ( P<0.05), in groups B1 and B2 than in group A ( P<0.05), and in group B1 than in group B2 ( P<0.05). Imaging review showed that the distribution of bone cement in the coronal midline of injured vertebrae was significantly better in group B than in group A ( P<0.05), in groups B1 and B2 than in group A ( P<0.05), and in group B1 than in group B2 ( P<0.05). In group A, 7 cases had postoperative vertebral collapse and 8 cases had other vertebral fractures. In group B, only 1 case had postoperative vertebral collapse during follow-up. Bilateral percutaneous vertebroplasty in the treatment of osteoporotic thoracolumbar compression fractures can obtain good bone cement distribution and effectiveness when the puncture needle tips locate at different levels during operation. When the puncture needle tips locate at the upper 1/3 layer and the lower 1/3 layer of the vertebral body, respectively, the puncture sites are closer to the upper and lower endplates, and the injected bone cement is easier to connect with the upper and lower endplates.

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

To compare the functional and radiological outcome of different approaches of percutaneous vertebroplasty (PVP) in the treatment of osteoporotic vertebral compression fractures (OVCF), and to analyze the factors affecting postoperative re-fracture in patients with OVCF. Medical data of 76 patients with OVCF who underwent PVP in our hospital from January 2021 to December 2021 were analyzed retrospectively. Based on the different intraoperative approaches, patients were divided into Unilateral-group (n=36) and Bilateral-group (n=40). The perioperative indexes, clinical efficacy, and spinal nerve function of the two groups were compared. Logistic regression analysis was used to determine the risk factors of postoperative re-fracture in patients with OVCF. The functional outcome was assessed with Oswestry disability index (ODI), American Spinal Injury Association (ASIA) nerve function classification and pain with Visual analogue scale (VAS). The radiological outcome was assessed by noting change of anterior vertebral height and change of kyphosis Cobb angle. The amount of intraoperative bleeding, the number of X-ray irradiation and the volume of injected bone cement in the Unilateral-group were lower, and the operation time was shorter than Bilateral-group (all P<0.05). One week after the operation, the anterior height of the vertebral body was higher, the Cobb angle of kyphosis was lower, the VAS score was higher, and the ASIA grade was lower in the Unilateral-group compared to the Bilateral-group (P<0.05). Logistic regression analysis showed that the age, bone mineral density, volume of bone cement injection and PD were risk factors of postoperative re-fracture in patients with OVCF. Unilateral PVP treatment of OVCF has the advantages of less intraoperative bleeding, less X-ray irradiation and shorter operation time. At the same time, bilateral PVP is associated with improved bone cement dispersion, and the effect of improving patients' pain is better than that in the Unilateral PVP. Postoperative risk of re-fracture in OVCF patients correlated with age, bone mineral density, amount of bone cement injection and pedicle diameter.

Biomechanical comparison between unilateral and bilateral percutaneous vertebroplasty for osteoporotic vertebral compression fractures: A finite element analysis.

Background and objective: The osteoporotic vertebral compression fracture (OVCF) has an incidence of 7.8/1000 person-years at 55–65 years. At 75 years or older, the incidence increases to 19.6/1000 person-years in females and 5.2–9.3/1000 person-years in males. To solve this problem, percutaneous vertebroplasty (PVP) was developed in recent years and has been widely used in clinical practice to treat OVCF. Are the clinical effects of unilateral percutaneous vertebroplasty (UPVP) and bilateral percutaneous vertebroplasty (BPVP) the same? The purpose of this study was to compare biomechanical differences between UPVP and BPVP using finite element analysis. Materials and methods: The heterogeneous assignment finite element (FE) model of T11-L1 was constructed and validated. A compression fracture of the vertebral body was performed at T12. UPVP and BPVP were simulated by the difference in the distribution of bone cement in T12. Stress distributions and maximum von Mises stresses of vertebrae and intervertebral discs were compared. The rate of change of maximum displacement between UPVP and BPVP was evaluated. Results: There were no obvious high-stress concentration regions on the anterior and middle columns of the T12 vertebral body in BPVP. Compared with UPVP, the maximum stress on T11 in BPVP was lower under left/right lateral bending, and the maximum stress on L1 was lower under all loading conditions. For the T12-L1 intervertebral disc, the maximum stress of BPVP was less than that of UPVP. The maximum displacement of T12 after BPVP was less than that after UPVP under the six loading conditions. Conclusion: BPVP could balance the stress of the vertebral body, reduce the maximum stress of the intervertebral disc, and offer advantages in terms of stability compared with UPVP. In summary, BPVP could reduce the incidence of postoperative complications and provide promising clinical effects for patients.

Comparison of the effectiveness and safety of unilateral and bilateral percutaneous vertebroplasty for osteoporotic vertebral compression fractures: A protocol for systematic review and meta-analysis.

The objective of this study was to compare the efficacy of lateral and bilateral percutaneous vertebroplasty (PVP) in treating osteoporotic vertebral compression fractures (OVCFs). A comprehensive literature search was performed using PubMed, Cochrane Library, EMBASE, CMB, CNKI, Wanfang, and VIP databases between January 2014 and December 2020. The clinical efficacy of the 2 approaches was evaluated by comparing perioperative outcomes (operation time, X-ray exposure time, volume of injected cement), clinical outcomes (degree of vertebral height restoration, improvement of Cobb angle, visual analogue scale score, and Oswestry Disability Index scores), and operation-related complications (rate of cement leakage, adjacent vertebral fracture rate, and nerve root stimulation). Data were analyzed using RevMan 5.3.3 and Stata 15.1. A total of 237 related articles were retrieved, and 17 randomized controlled trials were included. Meta-analysis results showed that compared to bilateral PVP, unilateral PVP led to decreased operation times (mean difference [MD] = -15.24, 95% confidence interval [CI]: [-17.77, -12.70], P < .05), decreased X-ray exposure time (MD-8.94, 95% CI[-12.08,-5.80]; P < .01), decreased volumes of injected cement (MD-1.57, 95% CI[-2.00,-1.14]; P < .05), and lower incidence of cement leakage (risk ratio [RR] = 0.6,95% CL[0.48,0.77], P < .01). Patients that underwent unilateral PVP experienced more effective pain relief at the last follow-up (MD-0.09, 95% CI [-0.15,-0.03];P=.006 < .05) and had a low degree of vertebral height restoration (MD-0.38, 95% CL [-0.71, -0.06]; P=.02 < .05). However, no differences in adjacent vertebral fractures (RR 1.19, 95% CI [0.78,1.82]; P = .41 > .01), nerve root stimulation (RR 1.98, 95% CI [0.22, 17.90]; P = .54 > .01), improvement of Cobb angle (MD = -0.18, 95% CI [-0.49, 0.13], P = .26 > .01), and improvement of ODI score (MD = 0.22, 95% CI[-0.37, 0.80], P > .05) were found between the 2 approaches. Although both unilateral and bilateral PVP can improve the quality of life of this patient population by managing pain effectively, unilateral PVP offers more benefits, including shorter operation time and less fluoroscopy, and should be recommended in clinical practice for OVCFs.

Application of Curved Diffusion Needle in unilateral percutaneous vertebroplasty

To evaluate the effectiveness of Curved Diffusion Needle in unilateral percutaneous vertebroplasty (PVP) by compared with bilateral PVP. A clinical data of 93 patients with osteoporotic vertebral compression fracture (OVCF) treated with PVP between January 2020 and January 2021 was retrospectively analyzed, including 47 patients underwent unilateral PVP assisted with Curved Diffusion Needle (unilateral group) and 46 patients underwent bilateral PVP (bilateral group). There was no significant difference in gender, age, cause of injury, time from injury to operation, T value of bone mineral density, AO classification, distribution of injured vertebrae, and preoperative visual analogue scale (VAS) score, Oswestry disability index (ODI), relative height of injured vertebrae, and Cobb angle between the two groups ( P>0.05). The operation time, the amount of bone cement injection, the incidence of bone cement leakage, the bone cement diffusion distribution, VAS score, ODI, the relative height of injured vertebrae, and Cobb angle were recorded and compared between the two groups. All operations successfully completed. The operation time was significantly shorter in unilateral group than in bilateral group ( t=-13.936, P=0.000), and the amount of bone cement injection was significantly less in unilateral group than in bilateral group ( t=-13.237, P=0.000). The incidence of bone cement leakage in unilateral group was 19.14%, which was significantly lower than that in bilateral group (39.13%) ( χ 2=4.505, P=0.034). The score of bone cement distribution in unilateral group was 7.0±1.3, of which 41 cases were excellent and 6 cases were well. The score of bilateral group was 7.4±0.8, of which 43 cases were excellent and 3 cases were well. There was no significant difference in score and grading of bone cement distribution between the two groups ( t=-1.630, P=0.107; Z=-1.013, P=0.311). All patients were followed up and the follow-up time was 3-10 months (mean, 6.5 months) in unilateral group and 3-10 months (mean, 6.1 months) in bilateral group. The VAS score, ODI, the relative height of injured vertebrae, and Cobb angle at 24 hours after operation and last follow-up were significantly better than those before operation in the two groups ( P<0.05). There were significant differences in all indicators between 24 hours after operation and last follow-up ( P<0.05). There was no significant difference in all indexes between the two groups ( P>0.05) at the same time point after operation. During follow-up, there was no complication such as contralateral vertebral collapse, refracture, adjacent vertebral fracture, or local kyphosis in the two groups. Unilateral PVP assisted with Curved Diffusion Needle for OVCF is beneficial to the distribution of bone cement, which can not only achieve similar effectiveness to bilateral PVP, but also achieve shorter operation time, less bone cement injection, and lower risk of bone cement leakage.

A Nomogram for Predicting the Residual Back Pain after Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures.

Objective Current findings suggest that percutaneous vertebroplasty (PVP) is a suitable therapeutic approach for osteoporotic vertebral compression fractures (OVCFs). However, a significant minority of patients still experience residual back pain after PVP. The present retrospective study was designed to determine the risk factors for residual back pain after PVP and provides a nomogram for predicting the residual back pain after PVP. Methods We retrospectively reviewed the medical records of patients with single-segment OVCFs who underwent bilateral percutaneous vertebroplasty. Patients were divided into group N and group R according to the postoperative VAS score. Group R is described as the VAS score of residual back pain ≥ 4. Pre- and postoperative factors that may affect back pain relief were evaluated between two groups. Univariate and multivariate logistic regression analysis were performed to identify risk factors affecting residual back pain after PVP. We provided a nomogram for predicting the residual back pain and used the receiver operating characteristic curve (ROC), concordance index (C-index), calibration curve, and decision curve analyses (DCA) to evaluate the prognostic performance. Results Among 268 patients treated with PVP, 37 (13.81%) patients were classified postoperative residual back pain. The results of the multivariate logistical regression analysis showed that the presence of an intravertebral vacuum cleft (IVC) (OR 3.790, P=0.026), posterior fascia oedema (OR 3.965, P=0.022), severe paraspinal muscle degeneration (OR 5.804, P=0.01; OR 13.767, P < 0.001), and blocky cement distribution (OR 2.225, P=0.041) were independent risk factors for residual back pain after PVP. The AUC value was 0.780, suggesting that the predictive ability was excellent. The prediction nomogram presented good discrimination, with a C-index of 0.774 (0.696∼0.852) and was validated to be 0.752 through bootstrapping validation. The calibration curve of the nomogram demonstrated a good consistency between the probabilities predicted by the nomogram and the actual probabilities. The nomogram showed net benefits in the range from 0.06 to 0.66 in DCA. Conclusions The presence of IVC, posterior fascia oedema, blocky cement distribution, and severe paraspinal muscle degeneration were significant risk factors for residual back pain after PVP for OVCFs. Patients with OVCFs after PVP who have these risk factors should be carefully monitored for the possible development of residual back pain. We provide a nomogram for predicting the residual back pain after PVP.

Clinical observation of two bone cement distribution modes after percutaneous vertebroplasty for osteoporotic vertebral compression fractures

BackgroundCurrent findings suggest that percutaneous vertebroplasty(PVP) is a suitable therapeutic approach for osteoporotic vertebral compression fractures (OVCFs). The present retrospective study aimed to investigate the differences in clinical efficacy and related complications between the two bone cement distribution modes.MethodsWe retrospectively reviewed the medical records of the patients with single-segment OVCFs who underwent bilateral percutaneous vertebroplasty. Patients were divided into blocky and spongy group according to the type of postoperative bone cement distribution. Clinical efficacy and related complications was compared between the two bone cement distribution modes on 24 h after the operation and last follow-up.ResultsA total of 329 patients with an average follow up time of 17.54 months were included. The blocky group included 131 patients, 109 females(83.2 %) and 22 males(16.8 %) with a median age of 72.69 ± 7.76 years, while the Spongy group was made up of 198 patients, 38 females(19.2 %) and 160 males(80.8 %) with a median age of 71.11 ± 7.36 years. The VAS and ODI after operation improved significantly in both two groups. The VAS and ODI in the spongy group was significantly lower than that in the blocky group, 24 h postoperatively, and at the last follow-up. There were 42 cases (12.8 %) of adjacent vertebral fractures, 26 cases (19.8 %) in the blocky group and 16 cases (8.1 %) in the spongy group. There were 57 cases (17.3 %) of bone cement leakage, 18 cases (13.7 %) in blocky group and 39 cases (19.7 %) in the spongy group. At 24 h postoperatively and at the last follow-up, local kyphosis and anterior vertebral height were significantly corrected in both groups, but gradually decreased over time, and the degree of correction was significantly higher in the spongy group than in the block group. The change of local kyphosis and loss of vertebral body height were also less severe in the spongy group at the last follow-up.ConclusionsCompared with blocky group, spongy group can better maintain the height of the vertebral body, correct local kyphosis, reduce the risk of the vertebral body recompression, long-term pain and restore functions.

Percutaneous Vertebroplasty with Side-Opening Cannula or Front-Opening Cannula in the Treatment of Kummell Disease?

ObjectiveTo explore the effect of bone cement distribution, cement leakage, and clinical outcomes with side‐opening cannula for bone cement injection in percutaneous vertebroplasty (PVP) in treatment of Kummell disease.MethodsA prospective study of patients with Kummell disease undergoing PVP was conducted from April 2012 to September 2017. In total, 43 patients (11 males, 32 females) with Kummell disease who received bilateral PVP were included in the study. The patients were divided into front‐opening cannulas (FOC) group with front‐opening cannulas and side‐opening cannulas (SOC) group with side‐opening cannulas. All patients were followed up for 6 months. The patient general information such as gender, age, bone density, compression ratio, operative time, and location of fracture vertebrae were recorded. Visual analogue scale (VAS), Oswestry Disability Index (ODI), bone cement distribution, radiation exposure time, bone cement leakage rate and vertebral height, and kyphosis angle were measured and compared for two groups before surgery, 1 day and 6 months after surgery.ResultsA total of 43 patients were enrolled, including 11 males and 32 females, aged 61–84 years. The bone density (T value) was 2.5 ± 0.6 in FOC group and 2.4 ± 0.6 in SOC group (P > 0.05). The compression ratio and operative time were 36.1% ± 13.0%, 39.3 ± 7.9 min in FOC group and 35.2% ± 13.7%, 40.0 ± 10.7 min in SOC group (P > 0.05). There was no significance between FOC and SOC groups in the location of fracture vertebrae. All patients underwent at least 6 months of follow‐up. At 6 months postoperatively, the VAS and ODI were significantly higher in the FOC group (3.0 ± 0.8, 35.7% ± 2.1%) than in the SOC group (1.3 ± 0.4, 18.6% ± 2.4%) (P < 0.05). The cement leakage rate of the SOC group was 4.8%, which was lower than that of the FOC group (31.8%, P < 0.05), and the bone cement distribution ratio was higher than that of the FOC group (63.1% ± 7.9% vs 40.5% ± 8.6%, P < 0.05). At 6 months after operation, the height of the anterior and posterior vertebral bodies of the patients in the SOC group restored better than the FOC group (anterior SOC: FOC 5.1 ± 0.5 mm vs 4.5 ± 0.5 mm; posterior SOC: FOC 0.6 ± 0.1 mm vs 0.3 ± 0.1 mm, P < 0.05), and the kyphosis correction was more obvious than patients in FOC group (SOC: FOC 8.5° ± 1.4° vs 4.6° ± 0.8°, P < 0.05).ConclusionPercutaneous vertebroplasty with side‐opening cannula is safe and effective in avoiding bone cement leakage, improving bone cement distribution, and restoring vertebral height.

Reduced Puncture Time and Radiation Exposure of Percutaneous Transpedicular Puncture with Electronic Conductivity Device: A Randomized Clinical Trial

The present study introduced an electronic conductivity device (ECD) to reduce time of percutaneous transpedicular puncture and frequency of patient valid radiation exposure in percutaneous kyphoplasty (PKP) or percutaneous vertebroplasty (PVP). A randomized self-control clinical study was undertaken. Medical records of patients with vertebral compression fractures (VCFs) for bilateral PKP or PVP were collected, and each side was performed randomly with ECD or conventional trocar. We enrolled 61 patients (44 women, 17 men) with 75 vertebras with VCF. Compared with the conventional fluoroscopy group, significant reductions in puncture time (504.33 ± 152.03 vs. 652.68 ± 167.60 seconds; P < 0.001) and fluoroscopy frequency (5.11 ± 1.23 vs. 8.15 ± 1.83; P < 0.001) for each percutaneous puncture were observed in the ECD group. When compared with the VCFs ≤50% group, the 2 indexes in the VCFs >50% group were significantly increased. And in the ECD group, the learning curve in the VCFs >50% group showed a steeper decreasing trend than that in the VCFs ≤50% group. No complications were observed in any patient. ECD could reduce puncture time of percutaneous transpedicular puncture and exposure of radiation in PVP and PKP. ECD has more benefits in complicated transpedicular puncture in patients with vertebral compression >50%.

Unilateral versus bilateral percutaneous vertebroplasty for osteoporotic vertebral compression fractures in elderly patients: A meta-analysis.

Objective:To contrast the effects and complications in unilateral and bilateral percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures in elderly patients.Methods:Multiple databases were adopted to search relevant studies, and the articles eventually satisfied the criteria were included. All the meta-analyses were conducted with the Review Manager 5.2. To estimate the quality of each article, risk of bias table was performed.Results:Finally, 627 patients were enrolled in 9 studies and ultimately met the eligibility criteria. The unilateral and bilateral surgical samples were 314 and 313, respectively. The meta-analysis showed no significant difference in Visual Analog Scale/Score (VAS) (MD = −0.05, 95% confidence interval [CI] [−0.24, 0.13], P = .57), Oswestry Disability Index (ODI) score (MD = 0.03, 95% CI [−0.57, 0.62], P = .93) and cement leakage (OR = 1.00, 95% CI [0.67, 1.50], P = 1.00) between unilateral group and bilateral group. The surgery time of unilateral PVP is much less than that of bilateral PVP (MD = −8.42, 95% CI [−13.17, −3.66], P = .0005). Patients with bilateral PVP surgery have been injected more cement than patients with a unilateral surgery (MD = −2.56, 95% CI [−2.79, −2.33], P <.00001).ConclusionThis study demonstrated unipedicular approach is the preferred surgical technique for treatment of osteoporotic vertebral fracture (OVF) compared with bilateral PVP since unipedicular approach injects less cement and cost less surgery time.

Severe vertebra collapse due to vertebra osteonecrosis after percutaneous vertebroplasty

A 70-year-old woman complained of 2-week history of severe back pain and restricted motion after a traffic accident. A magnetic resonance imaging of the lumbar spine showed a T12 compression fracture (Figure A) and severe osteoporosis (T score: −3.4); visual analogue scale (VAS) score was 9. Bilateral percutaneous vertebroplasty was performed and a total of 4.5 mL of polymethylmethacrylate (PMMA) bone cement was injected (Figure B,C). The patient was totally free of back pain, and the VAS score was improved to be 3 at 1 week after surgery. She received risedronate sodium (5 mg/ day) and thoracolumbar hyperextension brace fixation for 1 month. However, on the 86th day after surgery, she complained of enhanced back pain without specific accident. A physical examination showed VAS score was 5, plain radiograph showed a T12 vertebra collapse and kyphoscoliosis (Figure D). Sagittal computed tomography (Figure E) and magnetic resonance imaging (Figure F) demonstrated a T12 intravertebral vacuum cleft sign, suggesting the possibility of a T12 vertebral osteonecrosis. We suggested percutaneous vertebroplasty for further treatment, but the patient refused. Wentao Wang, MD Kun Duan, MD Qu Wei, MD Qining Wu, MD Jijun Liu, MD Dingjun Hao, MD Department of Spine Surgery Hong Hui Hospital Xi’an Jiaotong University Health Science Center No. 555 East Youyi Rd, Beilin District Xi’an 710054, Shan’xi, China Department of General Surgery The 417th Hospital China National Nuclear Corporation (CNNC) No. 5 Kangfu Rd, Lintong District Xi’an 710061, Shan’xi, China

Unilateral or bilateral percutaneous vertebroplasty for acute osteoporotic vertebral fracture: a prospective study.

Percutaneous vertebroplasty (PVP) has been demonstrated to be effective in the treatment of acute osteoporotic vertebral fracture (AOVF). However, the matter of which surgical approach should be selected remains controversial. This research aims to compare the clinical results of unilateral and bilateral PVP for AOVF. From January 2008 to December 2011, 68 patients with AOVF were randomly assigned to the unilateral puncture group (n=36) or the bilateral group (n=32). These patients underwent percutaneous injection of polymethyl methacrylate into posterior pedicle by the unilateral or bilateral puncture approach. Visual analogue scale (VAS) and the Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO) were recorded on presentation, at 1 week, 3, 6, and 12 months after operation. The cement leakage was measured by x-ray and computed tomography scan. Follow-up data showed there were no significant differences in VAS and QUALEFFO between 2 groups at 1 week after PVP and only significant difference was observed between 2 groups at 3, 6, and 12 months after operation. The cement leakage was 52.7% in the unilateral puncture group and 28.1% in the bilateral group. Compared with unilateral puncture, use of bilateral approach during PVP may result in more superior long-term outcomes and less cement leakage for patients with AOVF.

Comparison of the long-term efficacy in single segment osteoporotic vertebral compression fractures: unilateral percutaneous vertebroplasty versus bilateral percutaneous vertebroplasty

Objective To investigate the long term clinical effect of unilateral and bilateral percutaneous vertebroplasty(PVP) on the treatment of single segment osteoporotic vertebral compression fractures (OVCFs).Methods A total of 95 patients with OVCFs were retrospectively investigated.Each patient completed Visual Assessment Score(VAS) and Short Form-36 (SF-36) questionnaires preoperatively and follow-up to the endpoints postoperatively to assess the long term effect of unilateral and bilateral PVP.Patients underwent unilateral PVP (44 cases),whereas others underwent bilateral PVP (51 cases).Results VAS of immediate postoperative score (2.69 ± 0.55),(2.50 ± 0.39) and the last follow-up score (2.63 ± 0.46),(2.48 ± 0.32) in both techniques of PVP were significantly lower than the preoperative score (7.56 ± 0.73),(7.45 ± 0.54) (t =1.895,1.801,all P ＜ 0.01).However,VAS score at each time point in the unilateral PVP and bilateral PVP showed no significant difference (P ＞ 0.05).The last follow-up SF-36 scores (84.92±2.88),(86.71 t 2.73) in unilateral PVP and bilateral PVP were significantly higher than the preoperative score (58.35 ± 2.69),(57.93 ± 2.45) (P ＜ 0.01).But each time point of the SF-36 scores in both groups showed no significant difference (P ＞ 0.05).Unilateral percutaneous vertebroplasty showed some advantages on operation time,radiation exposure and usage of bone cement.Meanwhile,the bone cement leakage and recurrence of OVCFs on the adjacent segment in the two groups presented no significance.Conclusion Both unilateraland bilateral PVP could benefit the long term outcome of OVCFs,with regard to the significant advantage of unilateral PVP on operation time,radiation exposure and usage of bone cement. Key words: Osteoporosis; Fractures,Compression; Spine; Orthopedic Procedures; Radiography,Interventional

Temperature Measurement During Polymerization of Bone Cement in Percutaneous Vertebroplasty: An In Vivo Study in Humans

Aim of the study was to "in vivo" measure temperature, during percutaneous vertebroplasty (PV), within a vertebral body injected with different bone cements. According to the declaration of Helsinki, 22 women (60-80 years; mean, 75 years) with painful osteoporotic vertebral collapse underwent bilateral transpedicular PV on 22 lumbar vertebrae. Two 10-G vertebroplasty needles were introduced into the vertebra under digital fluoroscopy; a 16-G radiofrequency thermoablation needle (Starburst XL; RITA Medical System Inc., USA), carrying five thermocouples, was than coaxially inserted. Eleven different bone cements were injected and temperatures were measured every 30 s until temperatures dropped under 45 degrees C. After the thermocouple needle was withdrawn, bilateral PV was completed with cement injection through the vertebroplasty needle. Unpaired Student's t-tests, Kruskal-Wallis test, and Wilcoxon signed rank test were used to evaluate significant differences (p < 0.05) in peak temperatures, variations between cements, and clinical outcome. All procedures were completed without complications, achieving good clinical outcomes (p < 0.0001). Regarding average peak temperature, cements were divided into three groups: A (over 60 degrees C), B (from 50 degrees to 60 degrees C), and C (below 50 degrees C). Peak temperature in Group A (86.7 +/- 10.7 degrees C) was significantly higher (p = 0.0172) than that in Groups B (60.5 +/- 3.7 degrees C) and C (44.8 +/- 2.6 degrees C). The average of all thermocouples showed an extremely significant difference (p = 0.0002) between groups. None of the tested cements maintained a temperature >or=45 degrees C for more than 30 min. These data suggest that back-pain improvement is obtained not by thermal necrosis but by mechanical consolidation only. The relative necrotic thermal effect in vertebral metastases seems to confirm that analgesia must be considered the main intent of PV.