Unilateral percutaneous vertebroplasty in osteoporotic vertebral compression fractures: A clinical efficacy evaluation

Abstract

Osteoporotic vertebral compression fractures, often resulting from low-energy trauma, markedly impair the quality of life of elderly individuals. The present retrospective study focused on the clinical efficacy of unilateral percutaneous vertebroplasty (PVP) in the treatment of osteoporotic compression fractures. A total of 68 patients, representing 92 vertebral bodies, who underwent the unilateral PVP technique from March 2020 to January 2023 were evaluated. Key parameters such as visual analogue scale (VAS) values, Oswestry disability index (ODI) scores, Cobb angle measurements, and anterior vertebral height (AVH) were documented pre- and post-surgery. The mean follow-up period was 15.41±3.74 months. The mean pre-operative VAS score was 8.08±0.79, which was significantly reduced to 2.25±0.71 by 24 h post-surgery and stabilized at 1.58±0.51 by the final follow-up. The ODI showed a significant improvement from a pre-operative average of 67.75±7.91 to 19.74±2.90 post-surgery, and was maintained at a low level of 28.00±4.89 at the last assessment. Radiological evaluations revealed significant alterations in Cobb angle and AVH post-operation. Notably, during the follow-up, eight patients developed new compression fractures in different vertebral segments. In conclusion, the unilateral PVP method is safe and efficient for the management of osteoporotic vertebral compression fractures.

Keywords: elderly; osteoporotic fractures; quality of life; unilateral percutaneous vertebroplasty; vertebral compression fractures.

Figure 1

Pre- and post-operative imaging from the same patient. (A) Orthopantomogram of the preoperative X-ray image, (B) X-ray image in lateral position. (C) T1 sequence and (D) T2 sequence of the magnetic resonance imaging. The L2 and L3 vertebrae have abnormal signals on magnetic resonance as manifestations of new fractures. Skin entry points were determined from preoperative (E) axial and (F) sagittal images at the target level. Point c is the target puncture point; point b is the lateral margin of the superior articular eminence; point d is the skin entry point for unilateral abduction of the PVP; point a is the lateral margin of the pedicle root to the body projection point; and point e is the center of the spinous process to the body projection point. (G) Orthopantomogram of the post-surgical X-ray images. (H) Lateral X-ray image after surgery.

Figure 2

Anteroposterior and lateral views of the trajectory of the needle as it is inserted into the vertebral body via a unilateral extrapedicular puncture. (A) The vertebral body. (B) A long syringe needle is used to locate the puncture point. (C) The distal end of the fluoroscopic orthotopic puncture reaches the level of the vertebral midline, which is close to the preoperatively planned point. (D) The Kirschner needle is advanced to probe around the channel for bony structures. (E and F) Bone cement (0.5-1 ml) is injected and observed for leakage. (G and H) The position of the cement cannula is adjusted according to the dispersion of cement during the surgery.