Comparison of the efficacy of bilateral approach PVP and lateral hole injection combined with modified fluoroscopic unilateral approach PVP in the treatment of thoracolumbar osteoporotic fractures

Abstract

Objective: To compare the clinical efficacy of bilateral approach PVP and lateral injection combined with modified fluoroscopic unilateral approach PVP in the treatment of thoracolumbar osteoporotic fractures.

Methods: The clinical data of 100 patients with thoracolumbar osteoporotic fractures who received treatment in our hospital from January 2018 to January 2021 were retrospectively collected. According to the different surgical methods, group A included 48 patients who received bilateral approach PVP. Group B was composed of 52 patients who received lateral injection combined with modified fluoroscopy. General data, intraoperative data, and postoperative follow-up data of the two groups of patients were collected and statistically analyzed.

Results: There was no significant difference in the general data between the two groups (P > 0.05), and the two groups were comparable. In terms of intraoperative data, the operation time of group B was shorter than that of group A, and the difference was statistically significant (P < 0.05). The number of intraoperative fluoroscopies in group B was less than that in group A, the difference was statistically significant (P < 0.05), while patients in group A had a higher bone cement leakage rate, and the difference was statistically significant (P < 0.05). In terms of postoperative follow-up, there was no statistically significant difference in VAS and ODI scores 1 day before surgery between the two groups (P > 0.05), and statistically significant difference in VAS scores 1 day after surgery, 1,3 and 6 months after surgery between the two groups compared with 1 day before surgery (P < 0.05). The ODI scores 1,3 and 6 months after surgery were statistically significant compared with 1 day before surgery (P < 0.05), while the VAS and ODI scores of the two groups were not statistically significant 1 day after surgery and 1,3 and 6 months after surgery (P > 0.05).

Conclusion: Compared with the bilateral approach PVP, lateral injection combined with improved fluoroscopy has the advantages of shorter operation time, fewer intraoperative fluoroscopy times, and lower bone cement leakage rate.

Keywords: Osteoporosis; Percutaneous vertebroplasty; Vertebral fracture.

Fig. 1

A: Improved design of puncture kit, with the straight hole bone cement injection rod modified to a side hole, and used in combination during surgery. B: A 68-year-old female patient was admitted to the hospital with straight back pain after a fall. Admission X-ray; CT and MRI confirmed L2 vertebral compression fracture, with rupture of the left and anterior walls of the vertebral body. BMD: -3.8, indicating osteoporosis in the patient. C: During the operation, the fractured vertebral body was located, and there was significant compression on the left side of the vertebral body, which was located at the left pedicle. A left pedicle puncture is planned to be performed. D: Puncture into the left pedicle of L2, gradually deepening the process, increasing the outward tilt angle, and performing pedicle projection fluoroscopy (C-arm X-ray fluoroscopy machine rotates the angle to visualize the trabecular bone channel of the pedicle, clearly showing the inner wall of the pedicle and the gap between the upper and lower articular processes on the puncture side), confirming that the puncture sleeve has not crossed the inner wall of the pedicle, passing through the junction area of the pedicle and vertebral body, entering the posterior side of the vertebral body for fluoroscopy and further increasing the outward tilt angle, and entering the middle of the vertebral body. E: After the puncture is completed, the limited use of a lateral hole bone cement push rod is used to push the bone cement, with the lateral hole facing the opposite side, gradually pushing the bone cement. The lateral fluoroscopy is monitored to ensure that there is no peripheral leakage of the bone cement. Finally, a straight-hole bone cement push tube is used to push the last tube of bone cement, and the diffusion of the bone cement is confirmed by positive and lateral X-ray fluoroscopy. F: Postoperative X-ray observation showed satisfactory diffusion of bone cement and recovery of vertebral height. Postoperative CT re-examination showed satisfactory diffusion of bone cement within the vertebral body, with no obvious bone cement leakage near the midline of the vertebral body in front of the puncture channel