Clinical effect of unilateral puncture percutaneous kyphoplasty through transverse process-pedicle approach for the treatment of lumbar osteoporotic vertebral fractures_West China Medical Journal

Authors：

ZHANG Shuai ,  WANG Qing , WANG Song , XU Shuang

Orthopedics Department, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;

Corresponding?author：

WANG Qing, Email: wqspine2004@.163.com

Keywords：

Transverse-pedicle approach; Osteoporotic vertebral fracture; Percutaneous kyphoplasty; Clinical efficacy; Image evaluation

DOI：

10.7507/1002-0179.202008014

Video：

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Objective To observe the clinical effect of unilateral puncture percutaneous kyphoplasty (PKP) through transverse process-pedicle approach (TPA) for the treatment of lumbar osteoporotic vertebral fractures (OVF).Methods From January 2014 to June 2019, a total of 220 OVF patients (321 fractured vertebral bodies) were enrolled, and PKP was performed by unilateral TPA puncture. The distribution of bone cement in vertebral body exceeding the midline of vertebral body was defined as the success of puncture, and the success rates of puncture of different vertebral bodies were recorded. Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), anterior and middle heights of the vertebral body, and the local Cobb angle were compared between three time points namely before operation, 1 day after operation, and 6 months after operation. Surgery-related complications were recorded.Results The 220 patients included 57 males and 163 females, with a mean age of (70.3±6.5) years, a mean course of disease of (18.7±17.7) d, and a mean bone mineral density of ?3.3±0.6. The success rate of puncture from L₁ to L₅ was 81.7% (85/104), 95.2% (80/84), 100.0% (69/69), 97.6% (41/42), and 72.7% (16/22), respectively. The mean volume of bone cement injected into the vertebral bodies was (5.8±0.9) mL. Two patients were followed up for less than 6 months because of death or loss to follow-up, and the other 218 patients were followed up for 6-57 months, with an average of (19.6±8.7) months. Before surgery, 1 day after surgery, and 6 months after surgery, the median (lower quartile, upper quartile) of VAS scores was 6 (6, 8), 1 (1, 2), and 2 (1, 2), respectively, with statistically significant differences in all the two-two comparisons (P<0.017). At the three time points, the median (lower quartile, upper quartile) of ODI was 61% (54%, 66%), 26% (22%, 30%), and 25% (24%, 31%), respectively, the mean height of anterior vertebral body was (18.3±2.8), (22.6±3.0), and (22.6±3.1) mm, respectively, the mean height of middle vertebral body was (17.8±2.2), (22.9±2.8), and (22.9±2.7) mm, respectively, the mean local Cobb angle was (19.9±2.6), (14.4±2.8), (14.4±2.8)°, respectively, and the values at 1 day and 6 months after surgery all differed from those before surgery (P<0.017). A total of 32 cases (42 vertebrae) had bone cement leakage, of whom 4 cases had related symptoms. There were 32 re-fractures of the vertebral bodies, including 18 adjacent vertebral body fractures, with an incidence rate of 5.6%. There were 3 vertebral infections after operation, the incidence was 0.9%.Conclusion Patients with OVF of the lumbar spine undergoing unilateral TPA puncture for PKP surgery have a high success rate, definite clinical effect, and satisfactory correction of local deformities.

Citation： ZHANG Shuai, WANG Qing, WANG Song, XU Shuang. Clinical effect of unilateral puncture percutaneous kyphoplasty through transverse process-pedicle approach for the treatment of lumbar osteoporotic vertebral fractures. West China Medical Journal, 2020, 35(10): 1158-1163. doi: 10.7507/1002-0179.202008014 Copy

1.	中華醫學會骨質疏松和骨礦鹽疾病分會. 原發性骨質疏松癥診療指南(2017). 中華骨質疏松和骨礦鹽疾病雜志, 2017, 20(5): 413-443.
2.	Cauley JA. Osteoporosis: fracture epidemiology update 2016. Curr Opin Rheumatol, 2017, 29(2): 150-156.
3.	Borgstr?m F, Zethraeus N, Johnell O, et al. Costs and quality of life associated with osteoporosis-related fractures in Sweden. Osteoporos Int, 2006, 17(5): 637-650.
4.	安珍, 楊定焯, 張祖君, 等. 骨質疏松性脊椎壓縮性骨折流行病學調查分析. 中國骨質疏松雜志, 2002, 8(1): 82-83.
5.	郭世紱. 骨質疏松性椎體骨折. 中國矯形外科雜志, 2005, 13(22): 1685-1687.
6.	Karmakar A, Acharya S, Biswas D, et al. Evaluation of percutaneous vertebroplasty for management of symptomatic osteoporotic compression fracture. J Clin Diagn Res, 2017, 11(8): RC07-RC10.
7.	Lieberman IH, Dudeney S, Reinhardt MK, et al. Initial outcome and efficacy of "kyphoplasty" in the treatment of painful osteoporotic vertebral compression fractures. Spine (Phila Pa 1976), 2001, 26(14): 1631-1638.
8.	Kan SL, Yuan ZF, Chen LX, et al. Which is best for osteoporotic vertebral compression fractures: balloon kyphoplasty, percutaneous vertebroplasty or non-surgical treatment? A study protocol for a Bayesian network meta-analysis. BMJ Open, 2017, 7(1): e012937.
9.	Phillips FM, Ho E, Campbell-Hupp M, et al. Early radiographic and clinical results of balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures. Spine (Phila Pa 1976), 2003, 28(19): 2260-2265; discussion 2265-2267.
10.	Klazen CA, Lohle PN, De Vries J, et al. Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial. Lancet, 2010, 376(9746): 1085-1092.
11.	董雙海, 田紀偉, 王雷, 等. 應用經皮椎體成形術及經皮椎體后凸成形術治療骨質疏松性椎體壓縮骨折. 中華創傷雜志, 2011, 27(3): 236-240.
12.	楊炎, 王根林, 楊惠林, 等. 單側與雙側椎體后凸成形術治療骨質疏松性椎體壓縮骨折. 中國脊柱脊髓雜志, 2011, 21(6): 480-484.
13.	Tohmeh AG, Mathis JM, Fenton DC, et al. Biomechanical efficacy of unipedicular versus bipedicular vertebroplasty for the management of osteoporotic compression fractures. Spine (Phila Pa 1976), 1999, 24(17): 1772-1776.
14.	Wang S, Wang Q, Kang J, et al. An imaging anatomical study on percutaneous kyphoplasty for lumbar via a unilateral transverse process-pedicle approach. Spine (Phila Pa 1976), 2014, 39(9): 701-706.
15.	Lee ST, Chen JF. Closed reduction vertebroplasty for the treatment of osteoporotic vertebral compression fractures. Technical note. J Neurosurg, 2004, 100(4 Suppl Spine): 392-396.
16.	Kuklo TR, Polly DW, Owens BD, et al. Measurement of thoracic and lumbar fracture kyphosis: evaluation of intraobserver, interobserver, and technique variability. Spine (Phila Pa 1976), 2001, 26(1): 61-65; discussion 66.
17.	黃震源. 單、雙側經皮椎體后凸成形術治療骨質疏松性椎體壓縮骨折的療效. 中國脊柱脊髓雜志, 2011, 21(3): 202-206.
18.	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.
19.	Steinmann J, Tingey CT, Cruz G, et al. Biomechanical comparison of unipedicular versus bipedicular kyphoplasty. Spine (Phila Pa 1976), 2005, 30(2): 201-205.
20.	Sakaino S, Takizawa K, Yoshimatsu M, et al. Percutaneous vertebroplasty performed by the isocenter puncture method. Radiat Med, 2008, 26(2): 70-75.
21.	Rebolledo BJ, Gladnick BP, Unnanuntana A, et al. Comparison of unipedicular and bipedicular balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures: a prospective randomised study. Bone Joint J, 2013, 95-B(3): 401-406.
22.	Kim AK, Jensen ME, Dion JE, et al. Unilateral transpedicular percutaneous vertebroplasty: initial experience. Radiology, 2002, 222(3): 737-741.
23.	Yang XM, Wu TL, Xu HG, et al. Modified unilateral transpedicular percutaneous vertebroplasty for treatment of osteoporotic vertebral compression fractures. Orthop Surg, 2011, 3(4): 247-252.
24.	王高舉, 謝勝榮, 楊進, 等. 老年骨質疏松性椎體壓縮骨折和中青年胸腰椎骨折患者椎弓根寬度的CT觀察. 中國脊柱脊髓雜志, 2016, 26(12): 1076-1081.
25.	Ding J, Zhang Q, Zhu J, et al. Risk factors for predicting cement leakage following percutaneous vertebroplasty for osteoporotic vertebral compression fractures. Eur Spine J, 2016, 25(11): 3411-3417.
26.	Zhan Y, Jiang J, Liao H, et al. Risk factors for cement leakage after vertebroplasty or kyphoplasty: a meta-analysis of published evidence. World Neurosurg, 2017, 101: 633-642.
27.	Yeom JS, Kim WJ, Choy WS, et al. Leakage of cement in percutaneous transpedicular vertebroplasty for painful osteoporotic compression fractures. J Bone Joint Surg Br, 2003, 85(85): 83-89.
28.	曹珺, 劉紀恩, 母心靈, 等. PVP/PKP術后手術椎體再骨折的治療. 中國脊柱脊髓雜志, 2014, 24(10): 950-952.
29.	葉向陽, 湯立新, 程省, 等. 骨密度對骨質疏松性椎體壓縮性骨折PKP術后骨折再發風險的評估價值. 中國骨質疏松雜志, 2017, 23(2): 154-158.
30.	Belkoff SM, Maroney M, Fenton DC, et al. An in vitro biomechanical evaluation of bone cements used in percutaneous vertebroplasty. Bone, 1999, 25(2 Suppl): 23S-26S.
31.	Abdelrahman H, Siam AE, Shawky A, et al. Infection after vertebroplasty or kyphoplasty. A series of nine cases and review of literature. Spine J, 2013, 13(12): 1809-1817.

1. 中華醫學會骨質疏松和骨礦鹽疾病分會. 原發性骨質疏松癥診療指南(2017). 中華骨質疏松和骨礦鹽疾病雜志, 2017, 20(5): 413-443.
2. Cauley JA. Osteoporosis: fracture epidemiology update 2016. Curr Opin Rheumatol, 2017, 29(2): 150-156.
3. Borgstr?m F, Zethraeus N, Johnell O, et al. Costs and quality of life associated with osteoporosis-related fractures in Sweden. Osteoporos Int, 2006, 17(5): 637-650.
4. 安珍, 楊定焯, 張祖君, 等. 骨質疏松性脊椎壓縮性骨折流行病學調查分析. 中國骨質疏松雜志, 2002, 8(1): 82-83.
5. 郭世紱. 骨質疏松性椎體骨折. 中國矯形外科雜志, 2005, 13(22): 1685-1687.
6. Karmakar A, Acharya S, Biswas D, et al. Evaluation of percutaneous vertebroplasty for management of symptomatic osteoporotic compression fracture. J Clin Diagn Res, 2017, 11(8): RC07-RC10.
7. Lieberman IH, Dudeney S, Reinhardt MK, et al. Initial outcome and efficacy of "kyphoplasty" in the treatment of painful osteoporotic vertebral compression fractures. Spine (Phila Pa 1976), 2001, 26(14): 1631-1638.
8. Kan SL, Yuan ZF, Chen LX, et al. Which is best for osteoporotic vertebral compression fractures: balloon kyphoplasty, percutaneous vertebroplasty or non-surgical treatment? A study protocol for a Bayesian network meta-analysis. BMJ Open, 2017, 7(1): e012937.
9. Phillips FM, Ho E, Campbell-Hupp M, et al. Early radiographic and clinical results of balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures. Spine (Phila Pa 1976), 2003, 28(19): 2260-2265; discussion 2265-2267.
10. Klazen CA, Lohle PN, De Vries J, et al. Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial. Lancet, 2010, 376(9746): 1085-1092.
11. 董雙海, 田紀偉, 王雷, 等. 應用經皮椎體成形術及經皮椎體后凸成形術治療骨質疏松性椎體壓縮骨折. 中華創傷雜志, 2011, 27(3): 236-240.
12. 楊炎, 王根林, 楊惠林, 等. 單側與雙側椎體后凸成形術治療骨質疏松性椎體壓縮骨折. 中國脊柱脊髓雜志, 2011, 21(6): 480-484.
13. Tohmeh AG, Mathis JM, Fenton DC, et al. Biomechanical efficacy of unipedicular versus bipedicular vertebroplasty for the management of osteoporotic compression fractures. Spine (Phila Pa 1976), 1999, 24(17): 1772-1776.
14. Wang S, Wang Q, Kang J, et al. An imaging anatomical study on percutaneous kyphoplasty for lumbar via a unilateral transverse process-pedicle approach. Spine (Phila Pa 1976), 2014, 39(9): 701-706.
15. Lee ST, Chen JF. Closed reduction vertebroplasty for the treatment of osteoporotic vertebral compression fractures. Technical note. J Neurosurg, 2004, 100(4 Suppl Spine): 392-396.
16. Kuklo TR, Polly DW, Owens BD, et al. Measurement of thoracic and lumbar fracture kyphosis: evaluation of intraobserver, interobserver, and technique variability. Spine (Phila Pa 1976), 2001, 26(1): 61-65; discussion 66.
17. 黃震源. 單、雙側經皮椎體后凸成形術治療骨質疏松性椎體壓縮骨折的療效. 中國脊柱脊髓雜志, 2011, 21(3): 202-206.
18. 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.
19. Steinmann J, Tingey CT, Cruz G, et al. Biomechanical comparison of unipedicular versus bipedicular kyphoplasty. Spine (Phila Pa 1976), 2005, 30(2): 201-205.
20. Sakaino S, Takizawa K, Yoshimatsu M, et al. Percutaneous vertebroplasty performed by the isocenter puncture method. Radiat Med, 2008, 26(2): 70-75.
21. Rebolledo BJ, Gladnick BP, Unnanuntana A, et al. Comparison of unipedicular and bipedicular balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures: a prospective randomised study. Bone Joint J, 2013, 95-B(3): 401-406.
22. Kim AK, Jensen ME, Dion JE, et al. Unilateral transpedicular percutaneous vertebroplasty: initial experience. Radiology, 2002, 222(3): 737-741.
23. Yang XM, Wu TL, Xu HG, et al. Modified unilateral transpedicular percutaneous vertebroplasty for treatment of osteoporotic vertebral compression fractures. Orthop Surg, 2011, 3(4): 247-252.
24. 王高舉, 謝勝榮, 楊進, 等. 老年骨質疏松性椎體壓縮骨折和中青年胸腰椎骨折患者椎弓根寬度的CT觀察. 中國脊柱脊髓雜志, 2016, 26(12): 1076-1081.
25. Ding J, Zhang Q, Zhu J, et al. Risk factors for predicting cement leakage following percutaneous vertebroplasty for osteoporotic vertebral compression fractures. Eur Spine J, 2016, 25(11): 3411-3417.
26. Zhan Y, Jiang J, Liao H, et al. Risk factors for cement leakage after vertebroplasty or kyphoplasty: a meta-analysis of published evidence. World Neurosurg, 2017, 101: 633-642.
27. Yeom JS, Kim WJ, Choy WS, et al. Leakage of cement in percutaneous transpedicular vertebroplasty for painful osteoporotic compression fractures. J Bone Joint Surg Br, 2003, 85(85): 83-89.
28. 曹珺, 劉紀恩, 母心靈, 等. PVP/PKP術后手術椎體再骨折的治療. 中國脊柱脊髓雜志, 2014, 24(10): 950-952.
29. 葉向陽, 湯立新, 程省, 等. 骨密度對骨質疏松性椎體壓縮性骨折PKP術后骨折再發風險的評估價值. 中國骨質疏松雜志, 2017, 23(2): 154-158.
30. Belkoff SM, Maroney M, Fenton DC, et al. An in vitro biomechanical evaluation of bone cements used in percutaneous vertebroplasty. Bone, 1999, 25(2 Suppl): 23S-26S.
31. Abdelrahman H, Siam AE, Shawky A, et al. Infection after vertebroplasty or kyphoplasty. A series of nine cases and review of literature. Spine J, 2013, 13(12): 1809-1817.

West China Medical Journal

Clinical effect of unilateral puncture percutaneous kyphoplasty through transverse process-pedicle approach for the treatment of lumbar osteoporotic vertebral fractures

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