Efficacy of percutaneous vertebroplasty using cross-puncture in the treatment of Genant grade 0-1 osteoporotic vertebral compression fractures

Guobing Hao; Zhenchuan Han; Nan Zhang; Kun Liu; Diyu Song; Shuming Zhang; Lin Qiao; Zexing Zhu

doi:10.1016/j.wneu.2024.123633

Efficacy of percutaneous vertebroplasty using cross-puncture in the treatment of Genant grade 0-1 osteoporotic vertebral compression fractures

World Neurosurg. 2024 Dec 28:123633. doi: 10.1016/j.wneu.2024.123633. Online ahead of print.

Authors

Guobing Hao¹, Zhenchuan Han¹, Nan Zhang¹, Kun Liu¹, Diyu Song¹, Shuming Zhang¹, Lin Qiao¹, Zexing Zhu²

Affiliations

¹ Department of Orthopaedics, PLA Rocket Force Medical Center, Beijing, 100088, China.
² Department of Orthopaedics, PLA Rocket Force Medical Center, Beijing, 100088, China. Electronic address: zhuzexing2024@163.com.

PMID: 39736313
DOI: 10.1016/j.wneu.2024.123633

Abstract

Background: Percutaneous vertebroplasty (PVP) is a common surgical method for osteoporotic vertebral compression fracture (OVCFs). The puncture method and location of the puncture needle can directly affect bone cement distribution in the vertebra. This retrospective study aimed to compare the clinical efficacy and safety of PVP using the cross-puncture and bilateral conventional puncture for the treatment of Genant grade 0-1 OVCFs.

Methods: We retrospectively analyzed 98 patients who underwent PVP in our department between January 2019 and April 2023, including 50 and 48 treated with the cross-puncture (group A) and bilateral conventional puncture (group B), respectively. Operation time (min), bone cement injection volume (mL), bone cement leakage rate, bone cement classification, and related complications were compared between the groups. The visual analog scale (VAS), Oswestry disability index (ODI), heights of the anterior and midline of the injured vertebrae, and Cobb angle were compared pre-operatively and at the follow-up. Excellent and good operation rates were evaluated using the modified Macnab criteria.

Results: The bone cement leakage rate in group B (25%) was higher than that in group A (8%) (P<0.05). However, the injection amount of bone cement in group A (5.47±0.72 mL) was significantly higher than that in group B (4.43±0.64 mL) (P<0.001). The bone cement distribution grades in group A (40 cases of grade 3) were significantly better than those in group B (0 cases of grade 3) (P<0.001). Compared with pre-operative values, the VAS and ODI scores at each follow-up significantly decreased, anterior and midline heights of the injured vertebrae significantly increased, and Cobb angle significantly decreased in both groups (P<0.001). The complication rate in group A (0%) was significantly lower than that in group B (10.42%) (P<0.05). According to the modified Macnab standard, the excellent and good ratings in group A (96%) were significantly higher than those in group B (62.5%) (P<0.001).

Conclusion: Cross-puncture and bilateral conventional puncture were both effective methods for the treatment of Genant grade 0-1 OVCFs. However, the cross-puncture was more advantageous in terms of the bone cement leakage rate, amount of bone cement injected, bone cement distribution grade, and complications.

Keywords: bone cement; cross-puncture; osteoporosis vertebral compression fractures; percutaneous vertebroplasty.