Safety and Efficacy of Percutaneous Vertebroplasty in Lateral Decubitus Position: A Retrospective Evaluation

Abstract

Background and Purpose: During a percutaneous vertebroplasty (PVP) procedure, patients typically lie in the prone position. However, some elderly patients have difficulty in maintaining the prone position. Therefore, we aimed to investigate the safety and efficacy of PVP in a lateral decubitus position in patients experiencing difficulty in maintaining the prone position. Materials and Methods: A total of 123 PVP procedures performed consecutively on 117 patients for symptomatic vertebral fractures caused by bone tumors or osteoporosis were studied. The patients were divided into prone (n=113) and decubitus groups (n=10) according to their positions during the PVP procedures. The factors related to the patients' background, procedures, therapeutic effects, and adverse events were compared between the 2 groups. Univariate analysis was performed using Student's t-test, Mann-Whitney's U-test, chisquared test, or Wilcoxon signed-rank test. Results: In the decubitus group, the average age was 6.7 years older (p<0.05), the average setup time was 1.6 times longer (p<0.01), the average fluoroscopic exposure dose was 1.37 times greater (p<0.05), the average dose-length product of interventional computed tomography was 1.78 times greater (p<0.05), and mobility restoration on the 7 th day after the PVP was less (p<0.05) compared to the prone group. There were no significant differences in bone cement leakage, pulmonary embolism, recurrence of compression fractures, or pain relief. Conclusion: Although some disadvantages were observed, decubitus PVP seemed to be completed safely and successfully. Decubitus PVP can become a treatment option for patients with vertebral fractures and difficulty in maintaining the prone position.

The usefulness of vertebral needle targeting simulation training system using ray-summation imaging: experimental study

“…The puncture direction is determined using a biplane view in most facilities. SNIPURS with a single-puncture view might be difficult for experts who have usually performed vertebral needle targeting with the isocenter puncture (ISOP) method [ 10 ], cathelin needle-assisted puncture (CAP) method [ 25 ], or the angle fixation method [ 26 ]. Nevertheless, the experts obtained the highest scores of the three groups on each test and got a perfect score on Test 6 with no coaching.…”

Accuracy of vertebral puncture in percutaneous vertebroplasty

“…First, the patient was placed in the prone or lateral decubitus position [ 11 ] on the examining bed. The area of interest, which was confirmed with fluoroscopy as well as physical examination on the basis of percussion tenderness, was marked and sterilized.…”

“…To cover the shortcomings of bone biopsy needle puncturing using the ISOP method, the Cathelin needle used in the local anesthesia is placed as a guide using ISOP method. The insertion route is planned on the images acquired using the Cone-beam computed tomography (CT) or the interventional CT (IVR-CT), and the needle is punctured in parallel with the Cathelin needle [10][11][12]. This modification is called the Cathelin-needle-assisted puncture (CAP) method.…”

Current status and challenges of percutaneous vertebroplasty (PVP)

“…Difficulty in the use of prone position is thus one of the relative contraindications for PVP. The use of the lateral decubitus position for PVP is possible [ 47 ], but technically difficult. The PVP for patients with four or more spinal fractures may be accomplished in two or more sessions, because the safety of the in vivo use of two or more packs of bone cement preparation is not guaranteed.…”