Keywords
Bone cement
Minimal surgical procedure
Treatment outcome
Submitted : 2024-06-23
Accepted : 2024-07-08
Published : 2024-07-23
Abstract
Objective: To compare clinical outcomes of percutaneous vertebroplasty (PVP) through different surgical approaches and bone cement distribution in the treatment of osteoporotic vertebral compression fractures (OVCF). Methods: The clinical data of 231 patients with OVCF who underwent PVP from June 2020 to June 2022 were retrospectively analyzed. Clinical characteristics and surgical data were collected for statistical analysis. The total patients were divided into a unilateral approach group (Group UA) and a bilateral approach group (Group BA) according to different surgical approaches. Then, patients in Group BA were divided into a continuous bone cement group (Group CBC) and a discontinuous bone cement group (Group DBC) according to the distribution of bone cement. Results: In each group, the postoperative visual analog scale (VAS) score and Oswestry disability index (ODI) score were significantly decreased (P < 0.001). The operation time and fluoroscopy times of Group UA were less than those of Group BA (P < 0.001). However, compared with Group BA, Group UA had a lower mean VAS score (P = 0.013) and ODI score (P = 0.004) at the last follow-up. The VAS (P = 0.032) and ODI (P = 0.024) scores in the CBC group were significantly lower than those in the DBC group at the last follow-up. Conclusions: Unilateral PVP presented several advantages over bilateral PVP, particularly in terms of shorter surgery time, less fluoroscopy frequency, and less trauma. Continuous bone cement was closely related to good clinical outcomes. In clinical practice, we suggest unilateral PVP is performed for patients and ensure the continuity of bone cement for better clinical outcomes.
References
Choi SH, Kim DY, Koo JW, et al., 2020, Incidence and Management Trends of Osteoporotic Vertebral Compression Fractures in South Korea: A Nationwide Population-Based Study. Asian Spine J, 14(2): 220–228.
Chen H, Pan W, Zhang Y, et al., 2022, Epidemiological and Clinical Characteristics Analysis of 681 Cases of Thoracolumbar Osteoporotic Vertebral Compression Fractures. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi, 36(7): 873–880.
Láinez Ramos-Bossini AJ, López Zúñiga D, Ruiz Santiago F, 2021, Percutaneous Vertebroplasty Versus Conservative Treatment and Placebo in Osteoporotic Vertebral Fractures: Meta-Analysis and Critical Review of the Literature. Eur Radiol, 31(11): 8542–8553.
Liu Y, Liu J, Suvithayasiri S, et al., 2023, Comparative Efficacy of Surgical Interventions for Osteoporotic Vertebral Compression Fractures: A Systematic Review and Network Meta-Analysis. Neurospine, 20(4): 1142–1158.
Long Y, Yi W, Yang D, 2020, Advances in Vertebral Augmentation Systems for Osteoporotic Vertebral Compression Fractures. Pain Res Manag, (2020): 3947368.
Wang ZW, Wang GY, Liu DK, et al., 2023, Risk Factors for Residual Back Pain After PVP Treatment for osteoporotic Thoracolumbar Compression Fractures: A Retrospective Cohort Study. World Neurosurg, (180): e484–e493.
Li Q, Shi L, Wang Y, et al., 2021, A Nomogram for Predicting the Residual Back Pain after Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures. Pain Res Manag, (2021): 3624614.
Salari N, Darvishi N, Bartina Y, et al., 2021, Global Prevalence of Osteoporosis Among the World Older Adults: A Comprehensive Systematic Review and Meta-Analysis. J Orthop Surg Res, 16(1): 669.
Johnell O, Kanis JA, 2006, An Estimate of the Worldwide Prevalence and Disability Associated with Osteoporotic Fractures. Osteoporos Int, 17(12): 1726–1733.
Jin YZ, Lee JH, Xu B, et al., 2019, Effect of Medications on Prevention of Secondary Osteoporotic Vertebral Compression Fracture, Non-Vertebral Fracture, and Discontinuation due to Adverse Events: A Meta-Analysis of Randomized Controlled Trials. BMC Musculoskelet Disord, 20(1): 399.
Najjar E, Pasku D, Mardashti A, et al., 2023, The Influence of Osteoporotic Vertebral Fractures on Global Sagittal Alignment in Elderly Patients: A Systematic Review and Meta-Analysis. Eur Spine J, 32(7): 2580–2587.
Hinde K, Maingard J, Hirsch JA, et al., 2020, Mortality Outcomes of Vertebral Augmentation (Vertebroplasty and/or Balloon Kyphoplasty) for Osteoporotic Vertebral Compression Fractures: A Systematic Review and Meta-Analysis. Radiology, 295(1): 96–103.
Lin S, Cheng M, Liang W, et al., 2021, Efficacy of Vertebral Augmentation in the Treatment of Osteoporotic Vertebral Compression Fractures: A Systematic Review and Meta-Analysis. Ann Palliat Med, 10(11): 11767–11775.
Litin Y, Rastogi S, Agarwal A, et al., 2023, A Prospective Evaluation of Percutaneous Vertebroplasty in Osteoporotic Vertebral Compression Fracture Patients. Cureus, 15(6): e40255.
Xiong YC, Guo W, Xu F, et al., 2021, Refracture of the Cemented Vertebrae After Percutaneous Vertebroplasty: Risk Factors and Imaging Findings. BMC Musculoskelet Disord, 22(1): 459.
Dai H, Liu Y, Han Q, et al., 2022, Biomechanical Comparison Between Unilateral and Bilateral Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures: A Finite Element Analysis. Front Bioeng Biotechnol, (10): 978917.
Bu D, He X, 2023, Comparison of Different Approaches of Percutaneous Vertebroplasty in the Treatment of Osteoporotic Spinal Compression Fractures and Analysis of Influencing Factors of Re-Fracture. Pak J Med Sci, 39(1): 144–149.
Kim T, Park J, Cho J, et al., 2023, Quantitative Comparison of Vertebral Structural Changes After Percutaneous Vertebroplasty Between Unilateral Extrapedicular Approach and Bilateral Transpedicular Approach Using Voxel-Based Morphometry. Neurospine, 20(4): 1287–1302.
Chen Y, Zhang H, Chen H, et al., 2021, Comparison of the Effectiveness and Safety of Unilateral and Bilateral Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures: A Protocol for Systematic Review and Meta-Analysis. Medicine (Baltimore), 100(51): e28453.
Liu MX, Xia L, Zhong J, et al., 2020, Is it Necessary to Approach the Compressed Vertebra Bilaterally During the Process of PKP? J Spinal Cord Med, 43(2): 201–205.
Zhou C, Liao Y, Chen H, et al., 2023, Analysis of Optimal Volume Fraction Percentage and Influencing Factors of Bone Cement Distribution in Vertebroplasty Using Digital Techniques. J Orthop Surg Res, 18(1): 235.
Tan L, Wen B, Guo Z, et al., 2020, The Effect of Bone Cement Distribution on the Outcome of Percutaneous Vertebroplasty: A Case Cohort Study. BMC Musculoskelet Disord, 21(1): 541.
Ma YH, Tian ZS, Liu HC, et al., 2021, Predictive Risk Factors for Recollapse of Cemented Vertebrae After Percutaneous Vertebroplasty: A Meta-Analysis. World J Clin Cases, 9(12): 2778–2790.
Zhou C, Liao Y, Huang S, et al., 2022, Effect of Cement Distribution Type on Clinical Outcome After Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures in the Aging Population. Front Surg, (9): 975832.
Bao LS, Wu W, Zhong XH, et al., 2022, Effect of Bone Cement Distribution on the Clinical Outcome of Unilateral Transpedicular Puncture for Spinal Osteoporotic Fractures. Zhongguo Gu Shang, 35(5): 423–429.
Li Q, Long X, Wang Y, et al., 2021, Clinical Observation of Two Bone Cement Distribution Modes After Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures. BMC Musculoskelet Disord, 22(1): 577.