Effectiveness of unilateral percutaneous vertebroplasty for elderly osteoporotic vertebral compression fracture by different approaches with different symptom severity_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XU Hui ^1,2 , YANG Junsong ² , LIU Tuanjiang ² , HE Baorong ² , CHAI Xin ² ,  HAO Dingjun ²

1. Xi’an Medical University, Xi’an Shaanxi, 710068, P. R. China;
2. Department of Spine Surgery, Honghui Hospital Affiliated to Medical School of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P. R. China;

Corresponding author：

HAO Dingjun, Email: haodingjun@126.com

Keywords：

Percutaneous vertebroplasty; osteoporotic vertebral compression fracture; lateral margin height of vertebral body; unilateral pedicle approach

DOI：

10.7507/1002-1892.202211071

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Objective To explore the effectiveness of unilateral percutaneous vertebroplasty (PVP) through mild side and severe side approaches in the treatment of elderly osteoporotic vertebral compression fracture (OVCF). Methods The clinical data of 100 patients with OVCF with symptoms on one side who were admitted between June 2020 and June 2021 and met the selection criteria were retrospectively analyzed. The patients were divided into the severe side approach group (group A) and the mild side approach group (group B) according to the cement puncture access during PVP, with 50 cases in each group. There was no significant difference between the two groups in terms of general information such as gender composition, age, body mass index, bone density, damaged segments, disease duration, and chronic comorbidities (P>0.05). The lateral margin height of the vertebral body on the operated side in group B was significantly higher than that of group A (P<0.001). The pain level and spinal motor function were evaluated using the pain visual analogue scale (VAS) score and Oswestry disability index (ODI) before operation, at 1 day, 1 month, 3 months, and 12 months after operation in both groups, respectively. Results No intraoperative or postoperative complications such as bone cement allergy, fever, incision infection, and transient hypotension occurred in both groups. Four cases of bone cement leakage occurred in group A (3 cases of intervertebral leakage and 1 case of paravertebral leakage), and 6 cases of bone cement leakage occurred in group B (4 cases of intervertebral leakage, 1 case of paravertebral leakage, and 1 case of spinal canal leakage), and none of them had neurological symptoms. Patients in both groups were followed up 12-16 months, with a mean of 13.3 months. All fractures healed and the healing time ranged from 2 to 4 months, with a mean of 2.9 months. The patients had no complication related to infection, adjacent vertebral fracture, or vascular embolism during follow-up. At 3 months postoperatively, the lateral margin height of the vertebral body on the operated side in groups A and B were improved when compared with preoperative ones, and the difference between pre- and post-operative lateral margin height of the vertebral body in group A was higher than that in group B, all showing significant differences (P<0.001). The VAS scores and ODI in both groups improved significantly at all postoperative time points when compared with those before operation, and further improved with time after operation (P<0.05). The differences in VAS scores and ODI between the two groups before operation were not significant (P>0.05); VAS scores and ODI in group A were significantly better than those in group B at 1 day, 1 month, and 3 months after operation (P<0.05), but no significant difference was found between the two groups at 12 months after operation (P>0.05). Conclusion Patients with OVCF have more severe compression on the more symptomatic side of the vertebral body, and patients with PVP have better pain relief and better functional recovery when cement is injected through the severe symptomatic side.

Citation： XU Hui, YANG Junsong, LIU Tuanjiang, HE Baorong, CHAI Xin, HAO Dingjun. Effectiveness of unilateral percutaneous vertebroplasty for elderly osteoporotic vertebral compression fracture by different approaches with different symptom severity. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(2): 168-173. doi: 10.7507/1002-1892.202211071 Copy

1.	Wang L, Yu W, Yin X, et al. Prevalence of osteoporosis and fracture in China: The China osteoporosis prevalence study. JAMA Netw Open, 2021, 4(8): e2121106. doi: 10.1001/jamanetworkopen.2021.21106.
2.	Rapado A. General management of vertebral fractures. Bone, 1996, 18(3 Suppl): 191S-196S.
3.	Barr JD, Barr MS, Lemley TJ, et al. Percutaneous vertebroplasty for pain relief and spinal stabilization. Spine (Phila Pa 1976), 2000, 25(8): 923-928.
4.	Jensen ME, Evans AJ, Mathis JM, et al. Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures: technical aspects. AJNR Am J Neuroradiol, 1997, 18(10): 1897-1904.
5.	Peh WCG, Gilula LA, Peck DD. Percutaneous vertebroplasty for severe osteoporotic vertebral body compression fractures. Radiology, 2002, 223(1): 121-126.
6.	Lin CC, Shen WC, Lo YC, et al. Recurrent pain after percutaneous vertebroplasty. AJR Am J Roentgenol, 2010, 194(5): 1323-1329.
7.	Hoffmann RT, Jakobs TF, Trumm C, et al. Vertebroplasty in the treatment of osteoporotic vertebral body fracture. Eur Radiol, 2007, 17(10): 2656-2662.
8.	Yang JS, Liu JJ, Chu L, et al. Causes of residual back pain at early stage after percutaneous vertebroplasty: A retrospective analysis of 1, 316 cases. Pain Physician, 2019, 22(5): E495-E503.
9.	Li Y, Yue J, Huang M, et al. Risk factors for postoperative residual back pain after percutaneous kyphoplasty for osteoporotic vertebral compression fractures. Eur Spine J, 2020, 29(10): 2568-2575.
10.	Liebschner MA, Rosenberg WS, Keaveny TM. Effects of bone cement volume and distribution on vertebral stiffness after vertebroplasty. Spine (Phila Pa 1976), 2001, 26(14): 1547-1554.
11.	Wang H, Sribastav SS, Ye F, et al. Comparison of percutaneous vertebroplasty and balloon kyphoplasty for the treatment of single level vertebral compression fractures: A meta-analysis of the literature. Pain physician, 2015, 18(3): 209-222.
12.	Jegatheeswaran S, Selvam S, Sri Ramkumar V, et al. Novel strategy for f-HAp/PVP/Ag nanocomposite synthesis from fluoro based ionic liquid assistance: Systematic investigations on its antibacterial and cytotoxicity behaviors. Mater Sci Eng C Mater Biol Appl, 2016, 67: 8-19.
13.	Ha KY, Lee JS, Kim KW, et al. Percutaneous vertebroplasty for vertebral compression fractures with and without intravertebral clefts. J Bone Joint Surg (Br), 2006, 88(5): 629-633.
14.	Yokoyama K, Kawanishi M, Yamada M, et al. Comparative study of percutaneous vertebral body perforation and vertebroplasty for the treatment of painful vertebral compression fractures. AJNR Am J Neuroradiol, 2012, 33(4): 685-689.
15.	Li Y, Huang M, Chen J, et al. The impact of facet joint violation on clinical outcomes after percutaneous kyphoplasty for osteoporotic vertebral compression fractures. World Neurosurg, 2018, 119: e383-e388.

1. Wang L, Yu W, Yin X, et al. Prevalence of osteoporosis and fracture in China: The China osteoporosis prevalence study. JAMA Netw Open, 2021, 4(8): e2121106. doi: 10.1001/jamanetworkopen.2021.21106.
2. Rapado A. General management of vertebral fractures. Bone, 1996, 18(3 Suppl): 191S-196S.
3. Barr JD, Barr MS, Lemley TJ, et al. Percutaneous vertebroplasty for pain relief and spinal stabilization. Spine (Phila Pa 1976), 2000, 25(8): 923-928.
4. Jensen ME, Evans AJ, Mathis JM, et al. Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures: technical aspects. AJNR Am J Neuroradiol, 1997, 18(10): 1897-1904.
5. Peh WCG, Gilula LA, Peck DD. Percutaneous vertebroplasty for severe osteoporotic vertebral body compression fractures. Radiology, 2002, 223(1): 121-126.
6. Lin CC, Shen WC, Lo YC, et al. Recurrent pain after percutaneous vertebroplasty. AJR Am J Roentgenol, 2010, 194(5): 1323-1329.
7. Hoffmann RT, Jakobs TF, Trumm C, et al. Vertebroplasty in the treatment of osteoporotic vertebral body fracture. Eur Radiol, 2007, 17(10): 2656-2662.
8. Yang JS, Liu JJ, Chu L, et al. Causes of residual back pain at early stage after percutaneous vertebroplasty: A retrospective analysis of 1, 316 cases. Pain Physician, 2019, 22(5): E495-E503.
9. Li Y, Yue J, Huang M, et al. Risk factors for postoperative residual back pain after percutaneous kyphoplasty for osteoporotic vertebral compression fractures. Eur Spine J, 2020, 29(10): 2568-2575.
10. Liebschner MA, Rosenberg WS, Keaveny TM. Effects of bone cement volume and distribution on vertebral stiffness after vertebroplasty. Spine (Phila Pa 1976), 2001, 26(14): 1547-1554.
11. Wang H, Sribastav SS, Ye F, et al. Comparison of percutaneous vertebroplasty and balloon kyphoplasty for the treatment of single level vertebral compression fractures: A meta-analysis of the literature. Pain physician, 2015, 18(3): 209-222.
12. Jegatheeswaran S, Selvam S, Sri Ramkumar V, et al. Novel strategy for f-HAp/PVP/Ag nanocomposite synthesis from fluoro based ionic liquid assistance: Systematic investigations on its antibacterial and cytotoxicity behaviors. Mater Sci Eng C Mater Biol Appl, 2016, 67: 8-19.
13. Ha KY, Lee JS, Kim KW, et al. Percutaneous vertebroplasty for vertebral compression fractures with and without intravertebral clefts. J Bone Joint Surg (Br), 2006, 88(5): 629-633.
14. Yokoyama K, Kawanishi M, Yamada M, et al. Comparative study of percutaneous vertebral body perforation and vertebroplasty for the treatment of painful vertebral compression fractures. AJNR Am J Neuroradiol, 2012, 33(4): 685-689.
15. Li Y, Huang M, Chen J, et al. The impact of facet joint violation on clinical outcomes after percutaneous kyphoplasty for osteoporotic vertebral compression fractures. World Neurosurg, 2018, 119: e383-e388.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of unilateral percutaneous vertebroplasty for elderly osteoporotic vertebral compression fracture by different approaches with different symptom severity

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