The Usefulness and Technique of Unilateral Extrapedicular Approach in Vertebroplasty

Seong-Jun Ahn; Bu-Hwan Kim; Moo-Ho Song; Seong-Ho Yoo; Doo-Jae Lee

doi:10.4184/jkss.2011.18.4.195

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Ahn, Kim, Song, Yoo, and Lee: The Usefulness and Technique of Unilateral Extrapedicular Approach in Vertebroplasty

Original Article

Journal of Korean Spine Surg 2011;18(4):195-201.

Published online: 21 December 2011

DOI: https://doi.org/10.4184/jkss.2011.18.4.195

The Usefulness and Technique of Unilateral Extrapedicular Approach in Vertebroplasty

Seong-Jun Ahn, M.D., Bu-Hwan Kim, M.D., Moo-Ho Song, M.D., Seong-Ho Yoo, M.D., Doo-Jae Lee, M.D.

Department of Orthopaedic Surgery, Daedong General Hospital, Busan, Korea

Corresponding author: Moo-Ho Song, M.D. Department of Orthopaedic Surgery, Daedong General Hospital, 530-1 Myungyun 1-Dong, Dongrae-Gu, Busan, Korea TEL: 82-451-554-8996, FAX: 82-451-553-7575 E-mail: ahnsjosdept@naver.com

Received 4 August 2011 Revised 6 November 2011 Accepted 25 November 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

A retrospective study.

Objectives

To evaluate the effectiveness of unilateral extrapedicular approach in the treatment of osteoporotic compression fracture, as compared to transbipedicular approach.

Summary of Literature Review

There has been no comparative study assessing this topic.

Materials and Methods

115 patients presenting with percutaneous vertebroplasty between Mar. 2002 and Feb. 2009, were divided into three groups: Group A (43 vertebrae; 29 patients) who were treated with bipedicular approach, Group B (66 vertebrae; 47 patients) treated with early cases of unilateral extrapedicular approach, and Group C (43 vertebrae; 39 patients) treated with late cases of unilateral extrapedicular approach. We analyzed radiological test results including the volume of injected cement and the distribution of intravertebral body, cement leakage, height restoration and kyphosis correction. Statistical analysis was done using SPSS. Clinical results were analyzed using VAS scores.

Results

The mean followup period varied from one year at minimum to seven years and six months at maximum. The mean volume of injected cement was 3.39cc/5.39cc/3.79cc for groups A, B and C respectively. Cement leakage was at 13.4/34.8/12.8% in each group. Cement leakage was higher in group B, but most leakage took place in early cases that we tried to inject more and more cement in early inexperienced period. Bilaterally well distributed cement in the vertebral body was at 85.7/76.9% in groups B and C respectively. VAS scores improved from 8.4/8.3/8.5 preoperatively to 2.0/2.0/1.6 postoperatively.

Conclusions

Percutaneous vertebroplasty treated with unilateral extrapedicular approach can lessen perioperative operating time. This treatment led to clinical and radiologic results that were comparable to those with a bilateral transpedicular approach.

Keywords: Osteoporotic compression fracture, Vertebroplasty, Unilateral extrapedicular approach, Transbipeducular approach

REFERENCES

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Figures and Tables%

Fig. 1.

(A) Entry Point: in the AP spot, just lateral 0.5-1cm superolateral to vertebral body. in the lateral spot, needle should be located at junction of transverse process and facet joint or rib.(B) Needle should be inserted with appropriate convergency. Proper convergency is that needle tip is located at medial wall of pedicle in the AP spot. And 5mm anterior to posterior sagittal line in the lateral spot. (C) Recommandable final needle position is closer to midline of vertebral body in the AP spot. and anterior 3/4 of body in the lateral spot. (D) The postoperative plain film shows successful cement injection with bilateral distribution evenly.

Table 1.

Height restoration of vertebral body in each groups. (unit:%)

	Mean	Bipedicular		Extrapedicular (Early)		Extrapedicular (Latter)
	Mean	Mean	SD	Mean	SD	Mean	SD
	Preop.	72.7	17.1	70.3	16.8	72.4	13.8
Height loss	Postop.	80.4	13.5	78.8	14.9	83.4	14.7
Height loss	Last F/U	80.3	13.4	78.5	14.5	83.2	14.4
	% height restored	7.7	13.0	8.5	12.2	9.3	10.1

Table 2.

Correction of local kyphotic angle in each groups. (unit: degree)

	Mean	Bipedicular		Extrapedicular (Early)		Extrapedicular (Latter)
	Mean	Mean	SD	Mean	SD	Mean	SD
	Preop.	8.5	13.1	13.7	12.6	14.5	9.5
Kyphosis	Postop.	6.7	9.3	11.9	10.7	11.4	9.2
Kyphosis	Last F/U	7.4	9.1	12.4	10.5	11.7	9.1
	Correction of Kyphotic angle	0.9	5.0	1.3	3.4	3.4	2.2

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