Is It Necessary to Approach the Severe Osteoporotic Vertebral Biconcave-Shaped Fracture Bilaterally During the Process of PKP?

Abstract

Purpose The goal of this study was to explore the outcomes of unilateral and bilateral approach percutaneous kyphoplasty (PKP) using CT-guidance in the treatment of severe osteoporotic single-level vertebral biconcave-shaped fracture. Methods We retrospectively reviewed 89 patients with severe osteoporotic single-level vertebral biconcave-shaped fracture who had undergone unilateral and bilateral PKP surgeries using CT-guidance at our hospital between June 2013 and June 2019, and followed for at least 1 year. All patients were divided into unilateral (the transverse process-pedicle approach, n = 49) and bilateral (the pedicle approach, n = 40) groups. We collected the clinical and radiological evaluation results during postoperative and last follow-up periods. Results Our findings revealed that the surgery time for the unilateral group was significantly shorter than that of the bilateral group at P < 0.05. The amount of bone cement and radiation exposure of the unilateral group were significantly lesser than that of the bilateral group ( P < 0.05). Relative to preoperative data, the values of the VAS score and Oswestry disability index (ODI) were significantly improved at 1 day after surgery and the last follow-up in the two groups ( P < 0.05). Notably, the median height of vertebra at 1 day after surgery and the last follow-up in the unilateral group was significantly restored than that of preoperative data ( P < 0.05). However, the median height of vertebra at the same time intervals in the bilateral group showed no significant change compared with preoperative data ( P > 0.05). Furthermore, the rate of bone cement leakage and incidence of adjacent-level vertebra fracture were not significantly different in the two groups (P > 0.05). Finally, both groups can obtain an asymmetrical distribution of bone cement in the vertebra. Conclusion Compared to the bilateral PKP, unilateral PKP using CT-guidance in the treatment of the sOVBFs exhibits significantly shorter operation time, lesser radiation dose, and complications. Moreover, unilateral PKP can restore the median height of the vertebral body and eventually obtain a symmetrical distribution of bone cement in the vertebra.

Digital Subtraction Angiography-Guided Percutaneous Kyphoplasty in Treatment of Multi-Segmental Osteoporotic Vertebral Compression Fracture: A retrospective single-Center study

“…Since DSA can be used to assist surgery in different departments, the prevalence of equipment is high. 12 However, PKP treatment of multi-vertebral OVCF has not been reported for the DSA-guided unilateral lateral pedicle approach. Study Suggests unilateral approach percutaneous vertebroplasty is an effective treatment for multiple osteoporotic vertebral compression fractures.…”

“…Related studies have demonstrated that DSA-guided surgery can reduce intraoperative fluoroscopy times and radiation injury. 12 , 18 Furthermore, a recent study demonstrated that PKP guided by DSA could reduce the times and doses of fluoroscopy. 19 However, there is no report on the fluoroscopy dose of PKP guided by DSA in treating multi-vertebral osteoporotic fractures.…”

“…Recently, the application of DSA in surgery has gradually increased, and it is widely used in interventional surgery such as vascular surgery, neuro-surgery, and hepatobiliary surgery. 12 Research depicts that DSA assisted surgery can achieve accurate positioning, three-dimensional scanning, and fast and clear imaging, to improve puncture accuracy, reduce the number of fluoroscopies, and shorten the operation time. 13 However, to our knowledge, no studies on the safety and efficacy of DSA-assisted PKP in the treatment of multi-segment thoracolumbar OVCF have been reported to date.The aim of our study was to demonstrate that DSA - assisted PKP in the treatment of multi-segment thoracolumbar OVCF is safe and effective and can improve the effectiveness and safety of minimally invasive surgery for multi-segment thoracolumbar OVCF.Since 2016, our hospital has used DSA assisted PKP to treat patients with multi-segment thoracolumbar OVCF.…”

Comparison of unilateral and bilateral percutaneous kyphoplasty for the treatment of osteoporotic vertebral compression fractures associated with scoliosis

“…Bilateral PKP is considered the universal approach for the management of OVCF by injecting cement via both pedicles, and one important advantage of this approach is the good distribution of bone cement ( 19 , 24 ). By contrast, bilateral PKP has certain shortcomings, such as higher frequency of intraoperative fluoroscopy and risk of cement leakage ( 25 ). Compared with that in bilateral PKP, unilateral PKP is associated with reduced operation time and risk of puncture, but the disadvantage of uneven distribution of bone cement may lead to vertebral refracture.…”

Whether the Unilateral Transverse Process-pedicle Approach has Advantages over the Traditional Transpedicle Approach: A Systematic review and Meta-analysis

“…Because a successful puncture can not only avoid complications, it also promotes the symmetrical distribution of bone cement after puncture 4 . Although many puncture methods have been designed, including pedicle, paravertebral, anterolateral, and posterolateral approaches, PVA with CTPA under the C-arm is the most commonly used approach 5 6 . A unilateral pedicle approach can meet the surgical requirements at one time, but if the inclination is small, the cement usually deposits on one side of the vertebral body, and there is no force on the opposite side.…”