Unipedicular vertebroplasty for osteoporotic compression fracture using an individualized needle insertion angle.
OBJECTIVE
In the classic transpedicular vertebroplasty, second needle placement is routinely required at the same level. However, each patient requires a different needle insertion angle (NIA) at each site. Therefore, precise NIA is required for each fractured vertebral body. In this study, we performed a unipedicular approach through an individualized NIA that had been evaluated with axial magnetic resonance imaging before vertebroplasty.


METHODS
We performed percutaneous vertebroplasty (PVP) on 103 vertebrae in 63 consecutive patients (50 women, 13 men; mean age, 70.4 y; range, 56 to 87 y). Before PVP, we measured the NIA for each pedicle. If leakage occurred without midline cement crossover, the unipedicular approach was stopped and changed to a bipedicular approach.


RESULTS
PVPs were performed from T7 to L5. We considered a successful outcome of a unipedicular approach to be when the center of vertebral body was filled with cement. Successful unipedicular PVPs were performed in 93 (90.3%) of 103 cases. Fifty-six of 63 patients were included for the pain evaluation. There was a statistically significant difference (P<0.0001) between pre-visual analog scale (VAS) (84) and post-VAS (postoperatively at 1 d-VAS: 32, postoperatively at 1 mo-VAS: 34, and postoperatively at 3 mo-VAS: 37). No statistically significant difference was found between pre-NIAs and post-NIAs. A positive correlation was found between pre-NIAs and post-NIAs.


CONCLUSIONS
Unipedicular PVP can be performed safely, provided the operator has a thorough knowledge of the bony landmarks and the anatomy of the pedicle. A unipedicular approach could be considered first using individualized NIA at each vertebral level.
Chang
Won Sok
WS
Department of Anesthesiology and Pain Management, Wooridul Spine Hospital, Seoul, Korea. cws@wooridul.co.kr
Lee
Sang-Ho
SH
Choi
Won Gyu
WG
Choi
Gun
G
Jo
Byung-June
BJ
D000368:Aged; D000369:Aged, 80 and over; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D050815:Fractures, Compression / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009339:Needles / Q000706:statistics & numerical data*; D010147:Pain Measurement / Q000379:methods; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000150:complications / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D054854:Vertebroplasty / Q000379:methods*