Prospective study of percutaneous vertebroplasty through unilateral extreme extrapedicular approach for osteoporotic vertebral compression fracture

Objective To compare the clinical outcomes of unilateral extreme extrapedicular puncture versus bilateral transpedicular puncture in percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fracture. Methods A prospective cohort study was performed. Ninety-seven patients of osteoporotic vertebral compression fractures treated were selected from January 2016 to January 2018 in Beijing Friendship Hospital, Capital Medical University. There were 36 males and 61 females, aged (72.19±7.41) years, with an age range of 60-80 years. All the patients underwent PVP with different puncture methods were divided into unilateral puncture group(n=52) and bilateral puncture group(n=45). PVP was performed in the unilateral extreme extrapedicular puncture group by unilateral puncture of the pedicle, and PVP was performed by bilateral puncture of the pedicle in the bilateral transpedicular puncture group. All patients completed at least one year of follow-up after operation. The operation time, fluoroscopy times, cement volume, incidence of cement leakage, visual analogue score (VAS) of 1 week and 1 year after operation were observed. The measurement data were expressed as mean±standard deviation (Mean±SD), count data were expressed as percentage, the independent sample t test and the χ2 test were used for comparison between groups, and the paired t test was used for comparison within the group. Results The operation was successfully completed in both groups. No serious complications such as paraplegia, bone cement allergy, pulmonary embolism were occurred. In the unilateral puncture group, the operation time were (21.90±3.16) min, the fluoroscopy times were (15.46±2.86) times, the cement volume were (3.47±0.41) ml and the incidence of cement leakage was 44.23% (23/52), in the bilateral puncture group, the operation time were (31.64±6.90) min, the fluoroscopy times were (23.31±2.39) times, the cement volume were (4.66±0.61) ml and the incidence of cement leakage was 68.89% (31/45). The operation time, fluoroscopy times, cement volume and incidence of cement leakage of unilateral puncture group were significantly less than those of bilateral puncture group. The difference was statistically significant (P 0.05). Conclusions Compared with bilateral transpedicular puncture, PVP through unilateral extrapedicular puncture can achieve the same clinical effect. However, the latter can significantly reduce the operation time, the cement volume, fluoroscopy times and the incidence of cement leakage. Key words: Osteoporotic fractures; Spinal fractures; Fractures, compression; Vertebroplasty