Application of Curved Diffusion Needle in unilateral percutaneous vertebroplasty_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HUANG Huiyu ^1,2 , HU Haigang ² , LIN Xu ² ,  TAN Lun ^1,2 , WU Chao ^1,2 , GAO Tao ² , WANG Xiangyu ²

1. Department of Spine Surgery, Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China;
2. Department of Spine Surgery and Traumatology Surgery, Zigong Fourth People’s Hospital, Zigong Sichuan, 643000, P.R.China;

Corresponding author：

TAN Lun, Email: 109872653@qq.com

Keywords：

Osteoporotic vertebral compression fracture; percutaneous vertebroplasty; unilateral puncture; Curved Diffusion Needle

DOI：

10.7507/1002-1892.202107044

Video：

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Objective To evaluate the effectiveness of Curved Diffusion Needle in unilateral percutaneous vertebroplasty (PVP) by compared with bilateral PVP. Methods A clinical data of 93 patients with osteoporotic vertebral compression fracture (OVCF) treated with PVP between January 2020 and January 2021 was retrospectively analyzed, including 47 patients underwent unilateral PVP assisted with Curved Diffusion Needle (unilateral group) and 46 patients underwent bilateral PVP (bilateral group). There was no significant difference in gender, age, cause of injury, time from injury to operation, T value of bone mineral density, AO classification, distribution of injured vertebrae, and preoperative visual analogue scale (VAS) score, Oswestry disability index (ODI), relative height of injured vertebrae, and Cobb angle between the two groups (P>0.05). The operation time, the amount of bone cement injection, the incidence of bone cement leakage, the bone cement diffusion distribution, VAS score, ODI, the relative height of injured vertebrae, and Cobb angle were recorded and compared between the two groups. Results All operations successfully completed. The operation time was significantly shorter in unilateral group than in bilateral group (t=−13.936, P=0.000), and the amount of bone cement injection was significantly less in unilateral group than in bilateral group (t=−13.237, P=0.000). The incidence of bone cement leakage in unilateral group was 19.14%, which was significantly lower than that in bilateral group (39.13%) (χ²=4.505, P=0.034). The score of bone cement distribution in unilateral group was 7.0±1.3, of which 41 cases were excellent and 6 cases were well. The score of bilateral group was 7.4±0.8, of which 43 cases were excellent and 3 cases were well. There was no significant difference in score and grading of bone cement distribution between the two groups (t=−1.630, P=0.107; Z=−1.013, P=0.311). All patients were followed up and the follow-up time was 3-10 months (mean, 6.5 months) in unilateral group and 3-10 months (mean, 6.1 months) in bilateral group. The VAS score, ODI, the relative height of injured vertebrae, and Cobb angle at 24 hours after operation and last follow-up were significantly better than those before operation in the two groups (P<0.05). There were significant differences in all indicators between 24 hours after operation and last follow-up (P<0.05). There was no significant difference in all indexes between the two groups (P>0.05) at the same time point after operation. During follow-up, there was no complication such as contralateral vertebral collapse, refracture, adjacent vertebral fracture, or local kyphosis in the two groups. Conclusion Unilateral PVP assisted with Curved Diffusion Needle for OVCF is beneficial to the distribution of bone cement, which can not only achieve similar effectiveness to bilateral PVP, but also achieve shorter operation time, less bone cement injection, and lower risk of bone cement leakage.

Citation： HUANG Huiyu, HU Haigang, LIN Xu, TAN Lun, WU Chao, GAO Tao, WANG Xiangyu. Application of Curved Diffusion Needle in unilateral percutaneous vertebroplasty. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(12): 1587-1594. doi: 10.7507/1002-1892.202107044 Copy

1.	Sun Y, Ma H, Yang F, et al. Clinical efficacy and safety of zoledronic acid combined with PVP/PKP in the treatment of osteoporotic vertebral compression fracture: A systematic review and meta-analysis of randomized controlled trials. Biomed Res Int, 2021, 2021: 6650358. doi: 10.1155/2021/6650358.
2.	Lee HJ, Park J, Lee IW, et al. Clinical, radiographic, and morphometric risk factors for adjacent and remote vertebral compression fractures over a minimum follow-up of 4 years after percutaneous vertebroplasty for osteoporotic vertebral compression fractures: novel three-dimensional voxel-based morphometric analysis. World Neurosurg, 2019, 125: e146-e157.
3.	Takahara K, Kamimura M, Moriya H, et al. Risk factors of adjacent vertebral collapse after percutaneous vertebroplasty for osteoporotic vertebral fracture in postmenopausal women. BMC Musculoskelet Disord, 2016, 17: 12. doi: 10.1186/s12891-016-0887-0.
4.	Liang D, Ye LQ, Jiang XB, et al. Biomechanical effects of cement distribution in the fractured area on osteoporotic vertebral compression fractures: a three-dimensional finite element analysis. J Surg Res, 2015, 195(1): 246-256.
5.	苟永胜, 李海波, 付柏林, 等. 单双侧入路经皮椎体后凸成形术治疗伴伤椎后壁破损的骨质疏松性椎体压缩骨折近期疗效比较. 中国修复重建外科杂志, 2020, 34(10): 1281-1287.
6.	Chen YC, Zhang L, Li EN, et al. Unilateral versus bilateral percutaneous vertebroplasty for osteoporotic vertebral compression fractures in elderly patients: A meta-analysis. Medicine (Baltimore), 2019, 98(8): e14317. doi: 10.1097/MD.0000000000014317.
7.	Theodorou DJ, Theodorou SJ, Duncan TD, et al. Percutaneous balloon kyphoplasty for the correction of spinal deformity in painful vertebral body compression fractures. Clin Imaging, 2002, 26(1): 1-5.
8.	Chen B, Li Y, Xie D, et al. Comparison of unipedicular and bipedicular kyphoplasty on the stiffness and biomechanical balance of compression fractured vertebrae. Eur Spine J, 2011, 20(8): 1272-1280.
9.	Tsouknidas A, Savvakis S, Asaniotis Y, et al. The effect of kyphoplasty parameters on the dynamic load transfer within the lumbar spine considering the response of a bio-realistic spine segment. Clin Biomech (Bristol, Avon), 2013, 28(9-10): 949-955.
10.	Zhang L, Liu Z, Wang J, et al. Unipedicular versus bipedicular percutaneous vertebroplasty for osteoporotic vertebral compression fractures: a prospective randomized study. BMC Musculoskelet Disord, 2015, 16: 145. doi: 10.1186/s12891-015-0590-6.
11.	Zhong R, Liu J, Wang R, et al. Unilateral curved versus bipedicular vertebroplasty in the treatment of osteoporotic vertebral compression fractures. BMC Surg, 2019, 19(1): 193. doi: 10.1186/s12893-019-0653-y.
12.	Geng Z, Zhou Q, Shang G, et al. Short-term efficacy of the percutaneous vertebroplasty using a curved versus straight vertebroplasty needle in osteoporotic vertebral compression fractures. Orthopedics, 2021, 44(1): e131-e138.
13.	Li J, Lin J, Yang Y, et al. 3-dimensional printing guide template assisted percutaneous vertebroplasty: Technical note. J Clin Neurosci, 2018, 52: 159-164.
14.	Liu J, Tang J, Zhang Y, et al. Percutaneous vertebral augmentation for osteoporotic vertebral compression fracture in the midthoracic vertebrae (T_5-8): A retrospective study of 101 patients with 111 fractured segments. World Neurosurg, 2019, 122: e1381-e1387.
15.	Yan L, He B, Guo H, et al. The prospective self-controlled study of unilateral transverse process-pedicle and bilateral puncture techniques in percutaneous kyphoplasty. Osteoporos Int, 2016, 27(5): 1849-1855.
16.	Zhang W, Liu S, Liu X, et al. Unilateral percutaneous vertebroplasty for osteoporotic lumbar compression fractures: a comparative study between transverse process root-pedicle approach and conventional transpedicular approach. J Orthop Surg Res, 2021, 16(1): 73. doi: 10.1186/s13018-021-02219-6.
17.	Yan J, Liu Q, Zheng Y, et al. Effect of unilateral pulsed jet lavage prior to vertebroplasty on the intravertebral pressure and cement distribution. J Orthop Surg Res, 2020, 15(1): 259. doi: 10.1186/s13018-020-01779-3.
18.	Huang S, Zhu X, Xiao D, et al. Therapeutic effect of percutaneous kyphoplasty combined with anti-osteoporosis drug on postmenopausal women with osteoporotic vertebral compression fracture and analysis of postoperative bone cement leakage risk factors: a retrospective cohort study. J Orthop Surg Res, 2019, 14(1): 452. doi: 10.1186/s13018-019-1499-9.

1. Sun Y, Ma H, Yang F, et al. Clinical efficacy and safety of zoledronic acid combined with PVP/PKP in the treatment of osteoporotic vertebral compression fracture: A systematic review and meta-analysis of randomized controlled trials. Biomed Res Int, 2021, 2021: 6650358. doi: 10.1155/2021/6650358.
2. Lee HJ, Park J, Lee IW, et al. Clinical, radiographic, and morphometric risk factors for adjacent and remote vertebral compression fractures over a minimum follow-up of 4 years after percutaneous vertebroplasty for osteoporotic vertebral compression fractures: novel three-dimensional voxel-based morphometric analysis. World Neurosurg, 2019, 125: e146-e157.
3. Takahara K, Kamimura M, Moriya H, et al. Risk factors of adjacent vertebral collapse after percutaneous vertebroplasty for osteoporotic vertebral fracture in postmenopausal women. BMC Musculoskelet Disord, 2016, 17: 12. doi: 10.1186/s12891-016-0887-0.
4. Liang D, Ye LQ, Jiang XB, et al. Biomechanical effects of cement distribution in the fractured area on osteoporotic vertebral compression fractures: a three-dimensional finite element analysis. J Surg Res, 2015, 195(1): 246-256.
5. 苟永胜, 李海波, 付柏林, 等. 单双侧入路经皮椎体后凸成形术治疗伴伤椎后壁破损的骨质疏松性椎体压缩骨折近期疗效比较. 中国修复重建外科杂志, 2020, 34(10): 1281-1287.
6. Chen YC, Zhang L, Li EN, et al. Unilateral versus bilateral percutaneous vertebroplasty for osteoporotic vertebral compression fractures in elderly patients: A meta-analysis. Medicine (Baltimore), 2019, 98(8): e14317. doi: 10.1097/MD.0000000000014317.
7. Theodorou DJ, Theodorou SJ, Duncan TD, et al. Percutaneous balloon kyphoplasty for the correction of spinal deformity in painful vertebral body compression fractures. Clin Imaging, 2002, 26(1): 1-5.
8. Chen B, Li Y, Xie D, et al. Comparison of unipedicular and bipedicular kyphoplasty on the stiffness and biomechanical balance of compression fractured vertebrae. Eur Spine J, 2011, 20(8): 1272-1280.
9. Tsouknidas A, Savvakis S, Asaniotis Y, et al. The effect of kyphoplasty parameters on the dynamic load transfer within the lumbar spine considering the response of a bio-realistic spine segment. Clin Biomech (Bristol, Avon), 2013, 28(9-10): 949-955.
10. Zhang L, Liu Z, Wang J, et al. Unipedicular versus bipedicular percutaneous vertebroplasty for osteoporotic vertebral compression fractures: a prospective randomized study. BMC Musculoskelet Disord, 2015, 16: 145. doi: 10.1186/s12891-015-0590-6.
11. Zhong R, Liu J, Wang R, et al. Unilateral curved versus bipedicular vertebroplasty in the treatment of osteoporotic vertebral compression fractures. BMC Surg, 2019, 19(1): 193. doi: 10.1186/s12893-019-0653-y.
12. Geng Z, Zhou Q, Shang G, et al. Short-term efficacy of the percutaneous vertebroplasty using a curved versus straight vertebroplasty needle in osteoporotic vertebral compression fractures. Orthopedics, 2021, 44(1): e131-e138.
13. Li J, Lin J, Yang Y, et al. 3-dimensional printing guide template assisted percutaneous vertebroplasty: Technical note. J Clin Neurosci, 2018, 52: 159-164.
14. Liu J, Tang J, Zhang Y, et al. Percutaneous vertebral augmentation for osteoporotic vertebral compression fracture in the midthoracic vertebrae (T_5-8): A retrospective study of 101 patients with 111 fractured segments. World Neurosurg, 2019, 122: e1381-e1387.
15. Yan L, He B, Guo H, et al. The prospective self-controlled study of unilateral transverse process-pedicle and bilateral puncture techniques in percutaneous kyphoplasty. Osteoporos Int, 2016, 27(5): 1849-1855.
16. Zhang W, Liu S, Liu X, et al. Unilateral percutaneous vertebroplasty for osteoporotic lumbar compression fractures: a comparative study between transverse process root-pedicle approach and conventional transpedicular approach. J Orthop Surg Res, 2021, 16(1): 73. doi: 10.1186/s13018-021-02219-6.
17. Yan J, Liu Q, Zheng Y, et al. Effect of unilateral pulsed jet lavage prior to vertebroplasty on the intravertebral pressure and cement distribution. J Orthop Surg Res, 2020, 15(1): 259. doi: 10.1186/s13018-020-01779-3.
18. Huang S, Zhu X, Xiao D, et al. Therapeutic effect of percutaneous kyphoplasty combined with anti-osteoporosis drug on postmenopausal women with osteoporotic vertebral compression fracture and analysis of postoperative bone cement leakage risk factors: a retrospective cohort study. J Orthop Surg Res, 2019, 14(1): 452. doi: 10.1186/s13018-019-1499-9.

Chinese Journal of Reparative and Reconstructive Surgery

Application of Curved Diffusion Needle in unilateral percutaneous vertebroplasty

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