ObjectiveTo investigate the effectiveness of synchronous unilateral percutaneous kyphoplasty (PKP) in the treatment of double noncontiguous thoracolumbar osteoporotic vertebral compression fracture (OVCF). MethodsBetween December 2018 and September 2020, 27 patients with double noncontiguous thoracolumbar OVCF were treated by synchronous unilateral PKP. There were 11 males and 16 females, with an average age of 75.4 years (range, 66-92 years). The fractures were caused by falls in 22 cases and sprains in 5 cases. The time from injury to hospital admission was 0.5-7.0 days, with an average of 2.1 days. The fractured vertebrae located at T9 in 2 cases, T10 in 3 cases, T11 in 10 cases, T12 in 15 cases, L1 in 12 cases, L2 in 6 cases, L3 in 4 cases, and L4 in 2 cases. The volume of bone cement injected into each vertebral body, operation time, and intraoperative fluoroscopy times were recorded. Anteroposterior and lateral X-ray films of thoracolumbar spine were taken to observe the anterior height of the injured vertebra, the Cobb angle of kyphosis, and the diffusion and good distribution rate of bone cement in the thoracolumbar spine. Visual analogue scale (VAS) score and Oswestry disability index (ODI) were used to evaluate the pain and functional improvement. ResultsAll operations completed successfully. The operation time was 34-70 minutes, with an average of 45.4 minutes. The intraoperative fluoroscopy was 21- 60 times, with an average of 38.6 times. The volume of bone cement injected into each vertebral body was 2-9 mL, with an average of 4.3 mL. All patients were followed up 6-21 months, with an average of 11.3 months. X-ray film reexamination showed that the anterior height of the injured vertebra and Cobb angle at each time point after operation were significantly improved than those before operation (P<0.05), and there was no significant difference between different time points after operation (P>0.05). The distribution of bone cement was excellent in 40 vertebral bodies, good in 13 vertebral bodies, and poor in 1 vertebral body, and the excellent and good rate was 98.1% (53/54). The pain of all patients significantly relieved or disappeared, and the function improved. The VAS score and ODI at each time point after operation were significantly lower than those before operation (P<0.05), and there was no significant difference between different time points after operation (P>0.05).ConclusionFor the double noncontiguous thoracolumbar OVCF, the synchronous unilateral PKP has the advantages of simple puncture, less trauma, less intraoperative fluoroscopy, shorter operation time, satisfactory distribution of bone cement, etc. It can restore the height of the vertebral body, correct the kyphotic angle, significantly alleviate the pain, and improve the function.
ObjectiveTo evaluate the screw-placement accuracy and technical advantages of patient-specific three-dimensional (3D)-printed drill guide-assisted C2 pedicle screw placement in bone models derived from patients with basilar invagination, and to provide evidence for clinical screw-placement strategies in high-risk craniocervical junction deformities. MethodsPreoperative thin-slice CT data from 9 patients with basilar invagination treated between June 2016 and July 2025 were used. For each patient, two 1∶1-scale 3D-printed upper cervical spine models were fabricated, and assigned to the guide-assisted group and the freehand group by computer-generated block randomization. Bilateral C2 screws were inserted by the same spine surgeon according to a standardized protocol. In the guide-assisted group, screw placement was performed in the following sequence: guide positioning, guide pin insertion, guide removal followed by enlargement drilling, tapping, and screw insertion. In the freehand group, screw placement was performed by anatomical landmark-based localization, stepwise drilling with fluoroscopic correction, enlargement drilling and tapping, and screw insertion. The primary outcomes were postoperative CT-based Gertzbein-Robbins (GR) grading of screw position and the GR grade 0/1 acceptability rate. Secondary outcomes included entry-point deviation, axial angle deviation, and the number of fluoroscopic exposures. ResultsThe two assessors showed good agreement in GR grading, with a Kappa coefficient>0.80, indicating reliable evaluations. Postoperative CT assessment showed that the overall distribution of GR grades was significantly better in the guide-assisted group than in the freehand group (P<0.05). The GR grade 0/1 acceptability rate was higher in the guide-assisted group, but the difference was not significant (P>0.05). Entry-point deviation, axial angle deviation, and the number of fluoroscopic exposures were all significantly lower in the guide-assisted group than in the freehand group (P<0.05). ConclusionPatient-specific 3D-printed drill guides can reduce geometric deviations in C2 pedicle screw placement in basilar invagination and decrease the number of fluoroscopic exposures. They show a potential advantage in improving the GR grade 0/1 acceptability rate; however, further clinical studies with larger samples are needed for verification.
