Unilateral curved versus bipedicular vertebroplasty in the treatment of osteoporotic vertebral compression fractures

Abstract

Background: Vertebral compression fracture is one of the most common complications of osteoporosis. In this study an unilateral curved vertebroplasty device was developed, and the safety, effectiveness, and surgical parameters of curved vertebroplasty (CVP) in the treatment of painful osteoporotic vertebral compression fractures was investigated and compared with traditional bipedicular vertebroplasty (BVP).

Methods: We investigated 104 vertebral augmentation procedures performed over 36 months. CVP and BVP procedures were compared for baseline clinical variables, pain relief (Visual Analog Scale, VAS), disability improvement (Oswestry Disability Index, ODI), operation time, number of fluoroscopic images, volume of cement per level, and cement leakage rate for each level treated. Complications and refracture incidence were also recorded in the two groups.

Results: The VAS and ODI in both group had no significant difference preoperative (P > 0.05), and a significant postoperative improvement in the VAS scores and ODI was found in both group (P < 0.001). However, the CVP group had significantly lower operation time, number of fluoroscopic images, and cement leakage rate per level than the BVP group (P < 0.05); however, the volumes of cement per level were similar in the two groups (P > 0.05). Neither group had any serious complications. Five and two patients in the BVP group developed refractures at non-adjacent and adjacent levels, respectively, with one patient developing refractures twice; however, none of the patients in the CVP group developed refractures at any level.

Conclusions: Our findings revealed that both CVP and BVP were safe and effective treatments for osteoporotic vertebral compression fractures, and CVP entails a shorter operation time, less exposure to fluoroscopy, and lower rate of cement leakage.

Keywords: Bipedicular; Cement leakage; Curved approach; Osteoporotic vertebral compression fractures; Vertebroplasty; X-ray exposure.

Fig. 1

Percutaneous Curved Vertebroplasty Device a, Standard transpedicular approach; b, insert curved injection cannula via straight trocar into the contralateral hemivertebra body; c, orientation of the device avoids cannula access in the wrong position; d, e, The veutro design of the side opening near the tip of the curved cannula prevents distribution of cement into the posterior border of the vertebra; f, g, h, The cannula was withdrawn point-by-point and the bone cement (1–2 mL) was injected with a specially designed delivery at each point

Fig. 2

Flow chart for the study The number of cases is calculated by number of procedures

Fig. 3

Injection procedure comparison between curved and bipedicular approach vertebroplasty a, b, c, d: CVP group after the introducer was accessed into optimal position, the curved injection cannula is inserted, anteroposterior fluoroscopy the tip cross the midline, and lateral fluoroscopy the tip in the forepart of the vertebra body, cement was distribute in both side of the vertebra body. e, f, g, h: BVP group the two straight introducer were accessed into 1/3 forepart of the vertebra body in the lateral fluoroscopy, cement distribute in both side of the vertebra body while leaking into the intervertebral space