PERCUTANEOUS VERTEBROPLASTY: CLINICAL AND RADIOLOGICAL COMPARATIVE ANALYSIS BETWEEN THE POSTEROLATERAL AND THE TRANSPEDICULAR APPROACH.

Abstract

INTRODUCTION AND OBJECTIVE: To compare the clinical and radiological results of the unilateral posterolateral approach with the bilateral transpedicular approach in the treatment of osteoporotic fractures with percutaneous vertebroplasty (PV).

MATERIAL AND METHODS: 75 patients with 113 symptomatic osteoporotic vertebral fractures treated with PV were studied: 53 females and 22 males. Average age 70.5 years (41 – 91), average follow-up 24 months (12 – 50). A unilateral posterolateral approach was used in 84 vertebrae and a bilateral transpedicular approach in 29 vertebrae. The most frequently treated vertebrae were L1 (30 vertebrae), L2 (27), L3 (19) and D12 (14). A posterolateral approach was used in 63 vertebrae (80.8%) and a transpedicular bilateral approach in 15 (19.2%). X-ray and MRI at pre-op, post-op, three months, six months and annually; post-op C-T of all patients. The Visual Analogical Scale (VAS), and the Oswestry Disability Index (ODI)were used at pre-op and six month follow-up.

RESULTS: There were 72 cement leakages in 54 vertebrae (47.8%). In the posterolateral approach there were 33 cement leakages (39.3%), and there were 21 vertebrae with cement leaks (72.4%) in the bilateral transpedicular approach group. This difference is statistically significant (p=0.004). The cement leakages were classified in six anatomic groups. For the whole series cement leakages were more frequent to the proximal disk with 22 cases (19.5%), 11 leaks to the distal disk (9.7%), 9 to the external-vertebral venous plexus (8%), 10 paraparavertebral leaks (8.8%), 8 spinal canal leaks (7.1%), others 4 cases (3.5%) The most frequent cement leakage in both approaches is to the proximal disk. In the posterolateral approach the pre-op and post-op VAS were 7.76 and 2.66 as well as a pre-op and post-op ODI of 72 and 32.73. In the transpedicular approach the pre-op and post-op VAS were 7.71 and 2.21, and ODI of 66.3 and 28.04 respectively. No statistically significant differences were found in the clinical results between both groups.

CONCLUSION: The clinical outcomes for both approaches were similar, however the incidence of cement leakages is significantly higher in the transpedicular approach. We recommend the unilateral posterolateral approach in the treatment of osteoporotic vertebral fractures with PV to reduce the risk of cement leakage.