Bilateral percutaneous balloon kyphoplasty through unilateral transverse process-extrapedicular approach for osteoporotic vertebral compression fracture of lumbar_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

PAN Hong ¹ ,  DING Shuchen ¹ , ZHAO Xinhua ² , LIN Zongyang ¹ , YE Hong ¹ , NI Zhiming ¹ , FU Chudi ¹ , XIA Junjie ¹

1. Center of Orthopedics, the 903th Hospital of People’s Liberation Army, Hangzhou Zhejiang, 310001, P.R.China;
2. The Third Department of Orthopedics, Zhejiang Hospital, Hangzhou Zhejiang, 310001, P.R.China;

Corresponding?author：

DING Shuchen, Email: hheellll@126.com

Keywords：

Osteoporotic vertebral compression fracture; percutaneous kyphoplasty; spinal fracture; spinal puncture

DOI：

10.7507/1002-1892.202103028

Video：

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Objective To evaluate the feasibility and short-term effectiveness of bilateral percutaneous balloon kyphoplasty through unilateral transverse process-extrapedicular approach for osteoporotic vertebral compression fracture (OVCF) of lumbar.Methods A retrospective analysis was made on the clinical data of 93 patients with OVCF of lumbar who met the selection criteria between January 2018 and June 2019. According to the different surgical methods, they were divided into group A (44 cases, treated with bilateral percutaneous balloon kyphoplasty through unilateral transverse process-extrapedicular approach) and group B [49 cases, treated with percutaneous kyphoplasty (PKP) via bilateral transpedicle approach]. There was no significant difference in gender, age, body mass index, T value of bone mineral density, injury cause, fractured level, time from injury to operation, comorbidities, and preoperative Cobb angle of injured vertebra, visual analogue scale (VAS) score, and Oswestry disability index (ODI) between the two groups (P>0.05). The operation time, intraoperative fluoroscopy times, bone cement injection amount, and incidence of bone cement leakage were recorded and compared between the two groups; Cobb angle of the injured vertebrae, VAS score, and ODI were measured before operation, at 2 days and 1 year after operation. The contralateral distribution ratio of bone cement was calculated according to the anteroposterior X-ray film at 2 days after operation.Results The operation time and the intraoperative fluoroscopy times in group A were significantly less than those in group B (P<0.05). There was no bone cement adverse reactions, cardiac and cerebrovascular adverse events, and no complications such as puncture needles erroneously inserted into the spinal canal and nerve injuries occurred in the two groups. Bone cement leakage occurred in 6 cases and 8 cases in groups A and B, respectively, all of which were asymptomatic paravertebral or intervertebral leakage, and no intraspinal leakage occurred; the bone cement injection amount and incidence of bone cement leakage between the two groups showed no significant differences (P>0.05). The contralateral distribution ratio of bone cement in group A was significantly lower than that in group B (t=2.685, P=0.009). Patients in both groups were followed up 12-20 months, with an average of 15.3 months. The Cobb angle of the injured vertebrae, VAS score, and ODI in the two groups were significantly improved at 2 days after operation, however, the Cobb angle of the injured vertebra at 1 year after operation was significantly lost when compared with the 2 days after operation, the VAS score and ODI at 1 year after operation were significantly further improved when compared with the 2 days after operation, the differences were all significant (P<0.05). There was no significant difference in the Cobb angle of the injured vertebrae, VAS score, and ODI between the two groups at each time point after operation (P>0.05).Conclusion Bilateral percutaneous balloon kyphoplasty through unilateral transverse process-extrapedicular approach is comparable to bilateral PKP in short-term effectiveness with regard to fracture reduction, reduction maintenance, pain relief, and functional improvement. It has great advantages in reducing operation time and radiation exposure, although it is inferior in bone cement distribution.

Citation： PAN Hong, DING Shuchen, ZHAO Xinhua, LIN Zongyang, YE Hong, NI Zhiming, FU Chudi, XIA Junjie. Bilateral percutaneous balloon kyphoplasty through unilateral transverse process-extrapedicular approach for osteoporotic vertebral compression fracture of lumbar. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(8): 1007-1013. doi: 10.7507/1002-1892.202103028 Copy

1.	Si L, Winzenberg TM, Jiang Q, et al. Projection of osteoporosis-related fractures and costs in China: 2010-2050. Osteoporos Int, 2015, 26(7): 1929-1937.
2.	葛云林, 丁舒晨, 潘兵, 等. 單側經皮椎體后凸成形術治療腰四、五合并骶一椎體骨質疏松性壓縮骨折一例報告. 中華創傷骨科雜志, 2017, 19(3): 265-267.
3.	Cheng J, Muheremu A, Zeng X, et al. Percutaneous vertebroplasty vs balloon kyphoplasty in the treatment of newly onset osteoporotic vertebral compression fractures: A retrospective cohort study. Medicine (Baltimore), 2019, 98(10): e14793. doi: 10.1097/MD.0000000000014793.
4.	鄭博隆, 郝定均, 閆亮, 等. 自行研發的可彎曲椎體成形器在椎體成形術治療骨質疏松性胸椎壓縮骨折中的應用. 中華創傷骨科雜志, 2019, 21(10): 881-887.
5.	Chen W, Xie W, Xiao Z, et al. Incidence of cement leakage between unilateral and bilateral percutaneous vertebral augmentation for osteoporotic vertebral compression fractures: A meta-analysis of randomized controlled trials. World Neurosurg, 2019, 122: 342-348.
6.	Liu MX, Xia L, Zhong J, et al. Is it necessary to approach the compressed vertebra bilaterally during the process of PKP? J Spinal Cord Med, 2020, 43(2): 201-205.
7.	Chen X, Guo W, Li Q, et al. Is unilateral percutaneous kyphoplasty superior to bilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures? Evidence from a systematic review of discordant meta-analyses. Pain Physician, 2018, 21(4): 327-336.
8.	Chang W, Zhang X, Jiao N, et al. Unilateral versus bilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures: A meta-analysis. Medicine (Baltimore), 2017, 96(17): e6738. doi: 10.1097/MD.0000000000006738.
9.	Yilmaz A, ?akir M, Yüceta? C?, et al. Percutaneous kyphoplasty: Is bilateral approach necessary? Spine (Phila Pa 1976), 2018, 43(14): 977-983.
10.	Tan G, Li F, Zhou D, et al. Unilateral versus bilateral percutaneous balloon kyphoplasty for osteoporotic vertebral compression fractures: A systematic review of overlapping meta-analyses. Medicine (Baltimore), 2018, 97(33): e11968. doi: 10.1097/MD.0000000000011968.
11.	朱迪, 尚春風, 劉宏建, 等. 彎角穿刺針椎體成形技術治療胸、腰椎骨質疏松性椎體壓縮骨折. 中華骨科雜志, 2019, 39(12): 737-746.
12.	楊小彬, 郝定均, 賀園, 等. 單雙側經皮椎體后凸成形術治療胸腰段骨質疏松性椎體壓縮骨折的療效比較. 中華創傷雜志, 2019, 35(12): 1060-1067.
13.	Yan L, Jiang R, He B, et al. A comparison between unilateral transverse process-pedicle and bilateral puncture techniques in percutaneous kyphoplasty. Spine (Phila Pa 1976), 2014, 39(26 Spec No.): B19-26.
14.	Tang J, Guo WC, Hu JF, et al. Unilateral and bilateral percutaneous kyphoplasty for thoracolumbar osteoporotic compression fractures. J Coll Physicians Surg Pak, 2019, 29(10): 946-950.
15.	劉玉剛, 王炳輝, 龍游, 等. 經橫突上緣椎弓根外側入路單側穿刺經皮椎體成形術治療上腰椎骨質疏松性椎體壓縮骨折. 中華創傷雜志, 2018, 34(4): 312-318.
16.	Li H, Yang L, Tang J, et al. An MRI-based feasibility study of unilateral percutaneous vertebroplasty. BMC Musculoskelet Disord, 2015, 16: 162. doi: 10.1186/s12891-015-0619-x.
17.	熊森, 毛克亞, 韓振川, 等. 應用彎角椎體成形裝置修復胸腰段骨質疏松性椎體壓縮骨折. 中國組織工程研究, 2016, 20(17): 24456-24462.
18.	Kaufmann TJ, Trout AT, Kallmes DF. The effects of cement volume on clinical outcomes of percutaneous vertebroplasty. AJNR Am J Neuroradiol, 2006, 27(9): 1933-1937.
19.	Soon WC, Mathew RK, Timothy J. Comparison of vertebroplasty using directional versus straight needle. Acta Radiol Open, 2015, 4(3): 2047981615569268. doi: 10.1177/2047981615569268.

1. Si L, Winzenberg TM, Jiang Q, et al. Projection of osteoporosis-related fractures and costs in China: 2010-2050. Osteoporos Int, 2015, 26(7): 1929-1937.
2. 葛云林, 丁舒晨, 潘兵, 等. 單側經皮椎體后凸成形術治療腰四、五合并骶一椎體骨質疏松性壓縮骨折一例報告. 中華創傷骨科雜志, 2017, 19(3): 265-267.
3. Cheng J, Muheremu A, Zeng X, et al. Percutaneous vertebroplasty vs balloon kyphoplasty in the treatment of newly onset osteoporotic vertebral compression fractures: A retrospective cohort study. Medicine (Baltimore), 2019, 98(10): e14793. doi: 10.1097/MD.0000000000014793.
4. 鄭博隆, 郝定均, 閆亮, 等. 自行研發的可彎曲椎體成形器在椎體成形術治療骨質疏松性胸椎壓縮骨折中的應用. 中華創傷骨科雜志, 2019, 21(10): 881-887.
5. Chen W, Xie W, Xiao Z, et al. Incidence of cement leakage between unilateral and bilateral percutaneous vertebral augmentation for osteoporotic vertebral compression fractures: A meta-analysis of randomized controlled trials. World Neurosurg, 2019, 122: 342-348.
6. Liu MX, Xia L, Zhong J, et al. Is it necessary to approach the compressed vertebra bilaterally during the process of PKP? J Spinal Cord Med, 2020, 43(2): 201-205.
7. Chen X, Guo W, Li Q, et al. Is unilateral percutaneous kyphoplasty superior to bilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures? Evidence from a systematic review of discordant meta-analyses. Pain Physician, 2018, 21(4): 327-336.
8. Chang W, Zhang X, Jiao N, et al. Unilateral versus bilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures: A meta-analysis. Medicine (Baltimore), 2017, 96(17): e6738. doi: 10.1097/MD.0000000000006738.
9. Yilmaz A, ?akir M, Yüceta? C?, et al. Percutaneous kyphoplasty: Is bilateral approach necessary? Spine (Phila Pa 1976), 2018, 43(14): 977-983.
10. Tan G, Li F, Zhou D, et al. Unilateral versus bilateral percutaneous balloon kyphoplasty for osteoporotic vertebral compression fractures: A systematic review of overlapping meta-analyses. Medicine (Baltimore), 2018, 97(33): e11968. doi: 10.1097/MD.0000000000011968.
11. 朱迪, 尚春風, 劉宏建, 等. 彎角穿刺針椎體成形技術治療胸、腰椎骨質疏松性椎體壓縮骨折. 中華骨科雜志, 2019, 39(12): 737-746.
12. 楊小彬, 郝定均, 賀園, 等. 單雙側經皮椎體后凸成形術治療胸腰段骨質疏松性椎體壓縮骨折的療效比較. 中華創傷雜志, 2019, 35(12): 1060-1067.
13. Yan L, Jiang R, He B, et al. A comparison between unilateral transverse process-pedicle and bilateral puncture techniques in percutaneous kyphoplasty. Spine (Phila Pa 1976), 2014, 39(26 Spec No.): B19-26.
14. Tang J, Guo WC, Hu JF, et al. Unilateral and bilateral percutaneous kyphoplasty for thoracolumbar osteoporotic compression fractures. J Coll Physicians Surg Pak, 2019, 29(10): 946-950.
15. 劉玉剛, 王炳輝, 龍游, 等. 經橫突上緣椎弓根外側入路單側穿刺經皮椎體成形術治療上腰椎骨質疏松性椎體壓縮骨折. 中華創傷雜志, 2018, 34(4): 312-318.
16. Li H, Yang L, Tang J, et al. An MRI-based feasibility study of unilateral percutaneous vertebroplasty. BMC Musculoskelet Disord, 2015, 16: 162. doi: 10.1186/s12891-015-0619-x.
17. 熊森, 毛克亞, 韓振川, 等. 應用彎角椎體成形裝置修復胸腰段骨質疏松性椎體壓縮骨折. 中國組織工程研究, 2016, 20(17): 24456-24462.
18. Kaufmann TJ, Trout AT, Kallmes DF. The effects of cement volume on clinical outcomes of percutaneous vertebroplasty. AJNR Am J Neuroradiol, 2006, 27(9): 1933-1937.
19. Soon WC, Mathew RK, Timothy J. Comparison of vertebroplasty using directional versus straight needle. Acta Radiol Open, 2015, 4(3): 2047981615569268. doi: 10.1177/2047981615569268.

Chinese Journal of Reparative and Reconstructive Surgery

Bilateral percutaneous balloon kyphoplasty through unilateral transverse process-extrapedicular approach for osteoporotic vertebral compression fracture of lumbar

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