Effect of different cement distribution in bilateral and unilateral Percutaneous vertebro plasty on the clinical efficacy of vertebral compression fractures

Abstract

Background: The ramifications of osteoporotic fractures and their subsequent complications are becoming progressively detrimental for the elderly population. This study evaluates the clinical ramifications of postoperative bone cement distribution in patients with osteoporotic vertebral compression fractures (OVCF) who underwent both bilateral and unilateral Percutaneous Vertebroplasty (PVP).

Objective: The research aims to discern the influence of bone cement distribution on the clinical outcomes of both bilateral and unilateral Percutaneous Vertebroplasty. The overarching intention is to foster efficacious preventive and therapeutic strategies to mitigate postoperative vertebral fractures and thereby enhance surgical outcomes.

Methods: A comprehensive evaluation was undertaken on 139 patients who received either bilateral or unilateral PVP in our institution between January 2018 and March 2022. These patients were systematically classified into three distinct groups: unilateral PVP (n = 87), bilateral PVP with a connected modality (n = 29), and bilateral PVP with a disconnected modality (n = 23). Several operational metrics were juxtaposed across these cohorts, encapsulating operative duration, aggregate hospital expenses, bone cement administration metrics, VAS (Visual Analogue Scale) scores, ODI (Oswestry Disability Index) scores relative to lumbar discomfort, postoperative vertebral height restitution rates, and the status of the traumatized and adjacent vertebral bodies. Preliminary findings indicated that the VAS scores for the January and December cohorts were considerably reduced compared to the unilateral PVP group (P = 0.015, 0.032). Furthermore, the recurrence of fractures in the affected and adjacent vertebral structures was more pronounced in the unilateral PVP cohort compared to the bilateral PVP cohorts. The duration of the procedure (P = 0.000) and the overall hospitalization expenses for the unilateral PVP group were markedly lesser than for both the connected and disconnected bilateral PVP groups, a difference that was statistically significant (P = 0.015, P = 0.024, respectively). Nevertheless, other parameters, such as the volume of cement infused, incidence of cement spillage, ODI scores for lumbar discomfort, post-surgical vertebral height restitution rate, localized vertebral kyphosis, and the alignment of cement and endplate, did not exhibit significant statistical deviations (P > 0.05).

Conclusion: In juxtaposition with unilateral PVP, the employment of bilateral PVP exhibits enhanced long-term prognostic outcomes for patients afflicted with vertebral compression fractures. Notably, bilateral PVP significantly curtails the prevalence of subsequent vertebral injuries. Conversely, the unilateral PVP cohort is distinguished by its abbreviated operational duration, minimal invasiveness, and reduced overall hospitalization expenditures, conferring it with substantial clinical applicability and merit.

Keywords: Bone cement; Bone cement distribution; Osteoporotic vertebral compression fracture; Percutaneous vertebro plasty.

Fig. 1

Type of bone cement distribution. Section A represents the connection subset of the unilateral PVP group, with Parts ①② epitomizing the connection classification. Conversely, Section B symbolizes the bilateral PVP category, wherein Parts ①③ depict the non-connected bilateral PVP faction, and Parts ②④ embody the connected bilateral PVP faction

Fig. 2

Measurement of postoperative imaging parameters. Figure ①: Depicts two parallel lines drawn with respect to the fractured vertebra. Line A is aligned with the upper end plate of the vertebral body immediately superior to the fracture site, while Line B corresponds to the lower end plate of the vertebral body directly inferior to the fracture. Figure ②: Illustrates the structural facets of a preoperative vertebra. Specifically: A1 delineates the posterior edge, A2 represents the height corresponding to the preoperative fracture, A3 demarcates the anterior edge. Figure ③: Highlights the anatomical features of a typical vertebral body: B1 defines the posterior edge, B2 indicates the overall height of the vertebral body, and B3 pinpoints the anterior edge

Fig. 3

Flow chart of test grouping

Fig. 4

Comparison of VAS between the two groups

Fig. 5

Comparison of ODI between the two groups

Fig. 6

Postoperative x-ray and CT imaging. ① Bilateral PVP Disconnected group: Radiographic image (standing position).② Bilateral PVP Unconnected group: Computed Tomography (CT) scan (supine position). ③ Bilateral PVP Connecting group: CT scan (supine position). ④ Bilateral PVP Connected group: CT scan (supine position). ⑤ Unilateral PVP group: CT scan (supine position). ⑥ Preoperative vertebral height: Radiographic image wherein A1 denotes the posterior margin of the preoperative vertebra, A2 represents the height of the preoperative fracture, and A3 signifies the anterior margin of the preoperative vertebra. ⑦ PVP postoperative measured vertebral height: Radiographic image (standing position). B1 refers to the posterior margin of the vertebral body, B2 pertains to the height of the vertebral body, and B3 corresponds to the anterior boundary of the vertebral body