Could lateral decubitus position improve the cement distribution of unilateral percutaneous kyphoplasty in patients with osteoporotic vertebral compression fracture?

Abstract

Background: To determine the influence of lateral decubitus position on cement distribution of unilateral percutaneous kyphoplasty (PKP) in patients with osteoporotic vertebral compression fracture (OVCF).Methods: A retrospective review was performed on patients who underwent PKP for OVCF at the Spine Department of our hospital between January 2016 and January 2020. Unilateral PKP were performed by the same senior spinal surgeon team under local anesthesia. Patients were divided into two group according to positions with injecting cement. Complete symptom and radiographic evaluation information were gathered from each patient since the initial presentation. Then, the radiographic and symptomatic indexes between two groups were compared.Results: There were 190 patients included in this study. Ninety-four patients used to receive cement injection in lateral decubitus position while 96 patients were in prone position. A significantly longer surgical time (28.7±4.5 min vs. 26.8±4.3min) and more cement volume (6.14±0.66ml vs. 5.69±0.69ml) were found in lateral decubitus group. And visual analogue scale (VAS) scores were significantly lower (p <0.05) in lateral decubitus group one week after surgery. Compared with prone group, lateral decubitus group showed a significantly higher proportion of grade III cement distribution (18.2% vs. 7.3%, p<0.05) and a significantly lower cement leakage rate (13.8% vs. 26%, p<0.05).Conclusion: It is possible that lateral decubitus position can improve cement distribution, relieve acute pain more and decrease leakage incidence in OVCF patients with unilateral PKP，although it might be slightly time-consuming. It was recommended that position could be switched to lateral decubitus position during cement injection for unilateral PKP, especially when extraversion angle was small.