Clinical efficacy analysis of extrapedicular unilateral percutaneous vertebroplasty via the upper edge of the transverse process for lumbar osteoporotic vertebral compression fractures.

Abstract

Objective: To investigate the clinical effect of vertebroplasty through unilateral upper edge of transverse process in the treatment of lumbar osteoporotic vertebral compression fracture (OVCF), and to explore the surgical indications and operation points of this technique.

Methods: Ninety patients with osteoporotic vertebral compression fractures of the lumbar spine treated in our hospital from June 2020 to June 2021 were retrospectively analyzed and divided into the experimental group and the control group for vertebroplasty according to the principle of randomization; the experimental group was treated with a lateral pedicle approach through the upper edge of the unilateral transverse process, and the control group was treated with a unilateral pedicle approach. After more than 1 year of follow-up, the operation time, intraoperative fluoroscopy times, bone cement injection volume, Oswestry disability index (ODI), Visual analogue scale (VAS) were compared between the two groups to assess the functional recovery of the patients.

Results: There was no significant difference in the general data (age, gender, location and number of fractured vertebral bodies, and follow-up time) between the two groups before surgery. In the experimental group, there were 42 OVCF patients (15 males and 27 females), and the operated segments were L1 vertebral body in 17 cases, L2 vertebral body in 13 cases, L3 vertebral body in 8 cases, L4 vertebral body in 3 cases, and L5 vertebral body in 1 case. The control group consisted of 48 OVCF patients (16 males and 32 females), and the operated segments were L1 vertebral body in 21 cases, L2 vertebral body in 15 cases, L3 vertebral body in 8 cases, L4 vertebral body in 2 cases, and L5 vertebral body in 2 cases. In terms of operation time and intraoperative fluoroscopy times, the experimental group was less than the control group, and the difference had statistical significance (P < 0.05); in terms of bone cement injection volume, the difference between the two groups had no statistical significance (P > 0.05); in terms of pain VAS score and dysfunction index ODI score, the scores of the two groups were improved with the extension of follow-up time compared with those before surgery, but the difference between the two groups had no statistical significance (P > 0.05).

Conclusion: Compared with the traditional approach, PVP via the unilateral extrapedicular approach at the upper edge of the transverse process has the advantages of less operation time and fluoroscopy times, uniform diffusion of bone cement, and is comparable to the traditional surgical approach in relieving pain and improving patient function, but due to the limitation of the length of the puncture needle, careful operation is required during the operation.