Transverse process-pedicle approach versus conventional transpedicular approach in percutaneous kyphoplasty for osteoporotic vertebral compression fracture.

Background: Osteoporotic vertebral compression fracture (OVCF) has been shown to achieve favorable clinical outcomes after percutaneous kyphoplasty (PKP) performed via the transverse process-pedicle approach (TPPA). The aim of this study was to investigate the clinical advantages of PKP via TPPA for the treatment of OVCF, by comparing it with the conventional transpedicular approach (CTPA).

Methods: A retrospective study was conducted to analyze data from 124 patients with single-segment OVCF who were treated in our department between January 2019 and December 2022. A 1:1 propensity score matching was performed based on characteristics including sex, age, BMI, injury location, and bone mineral density T-values. The patients were divided into two groups: the TPPA group (62 cases), in which PKP was performed via the TPPA, and the CTPA group (62 cases), in which PKP was performed via the CTPA. Clinical efficacy was evaluated by comparing the two groups in terms of operative time, frequency of intraoperative fluoroscopy, rate of satisfactory bone cement distribution, rate of bone cement leakage, incidence of refractures, and visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores recorded at preoperative, 1-day, 3-month, 6-month, and 12-month postoperative time points. The Beck Index was also evaluated preoperatively, and at 1 day and 12 months postoperatively.

Results: There were no significant differences in baseline characteristics between the two groups, indicating comparability (P > 0.05). All surgeries were completed successfully without complications such as nerve injury or pedicle fracture. No significant differences were found between the groups in terms of operative time, intraoperative bleeding, or radiation frequency (P > 0.05). However, the amount of bone cement injected was significantly greater in the TPPA group compared to the CTPA group (P < 0.05). At 1 day postoperatively, the VAS score and ODI in the TPPA group were significantly lower than those in the CTPA group (P < 0.05), indicating better immediate pain relief and function. No significant differences in VAS or ODI were observed between the groups at preoperative, 3-month, 6-month, or 12-month time points (P > 0.05). Both VAS and ODI scores showed steady improvement within each group, with significant differences between all consecutive time points (P < 0.05). The Beck Index at both 1 day and 12 months postoperatively was significantly higher in the TPPA group compared to the CTPA group (P < 0.05). Within-group comparisons also showed significant improvement in the Beck Index at both postoperative time points compared with preoperative values (P < 0.05). Additionally, the TPPA group demonstrated a significantly higher rate of satisfactory bone cement distribution than the CTPA group (P < 0.05).

Conclusions: In the treatment of OVCF with PKP, the TPPA demonstrated comparable surgical safety to the CTPA. However, TPPA offered advantages in achieving better bone cement distribution, more effective immediate postoperative pain relief, and superior restoration and maintenance of the height of the injured vertebral body.

Clinical trial number: Not applicable. This study is a retrospective study, it is not a clinical trail.