Unipedicular versus bipedicular percutaneous vertebroplasty for osteoporotic vertebral compression fractures: a prospective randomized study

Abstract

BackgroundPercutaneous vertebroplasty (PVP) typically involves conventional lower-viscosity cement injection via bipedicular approach. Limited evidence is available comparing the clinical outcomes and complications in treating osteoporotic vertebral compression fractures (OVCFs) with PVP using high-viscosity cement through unipedicular or bipedicular approach.Methods and designFifty patients with OVCFs were randomly allocated into two groups adopting unipedicular or bipedicular PVP. The efficacy of unipedicular and bipedicular PVP was assessed by comparing operation time, X-ray exposure time, incidence of complications, vertebral height restoration, and improvement of the visual analogue scale (VAS), Oswestry disability index (ODI) and Short Form-36 (SF-36) General Health Survey scores.ResultsThe mean operative and exposure time to X-rays in the unipedicular PVP group was less than that of the bipedicular group (p < 0.05). No statistically significant differences were observed in the VAS score, ODI score, SF-36 score, cement leakage rate or vertebral height restoration between the two groups (p > 0.05).ConclusionUnipedicular and bipedicular PVP are safe and effective treatments for OVCF. Compared with bipedicular PVP, unipedicular PVP entails a shorter surgical time and lower X-ray irradiation.

ACR Appropriateness Criteria® Management of Vertebral Compression Fractures

“…Unilateral versus bilateral VP techniques have shown no statistical difference in visual analog scale score, Oswestry disability index, Short Form-36, cement leakage rate, or vertebral height restoration [21,26]. Because clinical outcome studies show essentially the same benefit of BK as VP for patient pain relief and mobility and similar complication rates, a multisociety (ACR-ASNR-ASSR-SIR-SNIS) panel of spine interventionalists holds the position that BK or VP may be considered to be appropriate and generally interchangeable techniques for the performance of VA [33].…”

“…Many studies have compared VP versus BK [21][22][23][24][25][26][27] and the timing of when VA is appropriate [18][19][20][28][29][30][31]. A thorough description of the indications and contraindications to VA are detailed in the ACR-ASNR-ASSR-SIR-SNIS Practice Parameter for the Performance of Vertebral Augmentation [32].…”

Extrapedicular Infiltration Anesthesia as an Improved Method of Local Anesthesia for Unipedicular Percutaneous Vertebroplasty or Percutaneous Kyphoplasty

“…Recent reports have claimed similar biomechanical stability and clinical efficacy of unipedicular PVP (PKP) as compared to bipedicular PVP (PKP). Therefore, the unipedicular procedure is advocated by most surgeons [ 4 – 6 ]. Lateral angulation of the puncture needle is required to approach the anterior third of the vertebral body near midline.…”

The Comparation of Ultrasound and Fluoroscopy-guided for Determining Puncture Entry Point of Percutaneous Vertebroplasty

“…At present, PVP is one of the effective treatment methods for OVCF, which is highly praised for its advantages like less trauma, signi cant pain relief and fast functional recovery [1][2][3] .The percutaneous transpedicular puncture is the rst step to perform PVP procedure, which is usually guided by X-ray uoroscopy. However, frequent X-ray uoroscopy will lead to the increase of radiation exposure to both surgeons and patients [4] . Ultrasonography (US) has been widely used in clinical practice [5] .…”