title: An MRI-based feasibility study of unilateral percutaneous vertebroplasty.
abstract: BACKGROUND
  Percutaneous vertebroplasty (PVP) has been demonstrated to be effective in the treatment of osteoporotic fracture. The bilateral pedicular approach is the most frequently used method. However, unilateral PVP is becoming increasingly more attractive for surgeons because of its numerous benefits, including lower radiation exposure, less tissue injury, and less bone cement leakage. The purpose of this study was to investigate the anatomical feasibility of unilateral PVP by exploring the differences in the puncture success rate of the unilateral pedicular approach among different lumbar segments, between men and women, and between the left and right sides.
  
  
  METHODS
  Punctures were simulated on magnetic resonance imaging scans of 200 patients (100 men, 100 women) at a maximum angle via a pedicular approach. The distance between the entry point and the midline of the vertebral body, the maximum puncture angle, the puncture success value, and the puncture success rate were measured and compared among different lumbar levels, between the two sexes, and between the left and right sides.
  
  
  RESULTS
  The maximum puncture distance between the entry point and the midline gradually increased from L1 to L5, and the maximum puncture angle showed the same tendency from L1 to L5. The puncture success values for L3 and L4 were higher than those for the other lumbar levels (L1, 31.53 ± 34.45; L2, 42.15 ± 28.06; L3, 56.21 ± 18.30; L4, 56.20 ± 12.93; and L5, 48.01 ± 6.88). The puncture success rates varied from 69.5 to 98.0 % among the different lumbar levels; L3 and L4 were the two highest (L3, 95.5 %; L4, 98.0 %). There were significant differences in these measurements between men and women and between the left and right sides.
  
  
  CONCLUSIONS
  PVP with the unilateral puncture approach appears more likely to succeed at L3 to L5 than at L1 and L2. The unilateral approach might be more suitable for men than women at levels other than L5. Additionally, the left pedicular approach might be optimal for unilateral PVP procedures.
authors.affiliation: Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China. handsome_lhj@139.com.
authors.forename: Haijun
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China. leiyangspine@163.com.
authors.forename: Lei
authors.initials: L
authors.lastname: Yang
authors.affiliation: Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China. near_spine@163.com.
authors.forename: Jian
authors.initials: J
authors.lastname: Tang
authors.affiliation: Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China. gdw02115252@163.com.
authors.forename: Dawei
authors.initials: D
authors.lastname: Ge
authors.affiliation: Department of Orthopedics, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China. 740358704@qq.com.
authors.forename: Hao
authors.initials: H
authors.lastname: Xie
authors.affiliation: Department of Radiology, Taizhou People's Hospital affiliated to Nantong University, Taizhou, Jiangsu Province, China. js.tz.cjh@163.com.
authors.forename: Jinhua
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China. nj_doctor_yu@sina.com.
authors.forename: Lipeng
authors.initials: L
authors.lastname: Yu
authors.affiliation: Department of Radiology, Taizhou People's Hospital affiliated to Nantong University, Taizhou, Jiangsu Province, China. tz_wei_haifeng@sina.com.
authors.forename: Haifeng
authors.initials: H
authors.lastname: Wei
authors.affiliation: Department of Radiology, Taizhou People's Hospital affiliated to Nantong University, Taizhou, Jiangsu Province, China. tz_tianweizhong@sina.com.
authors.forename: Weizhong
authors.initials: W
authors.lastname: Tian
authors.affiliation: Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China. nydsuitao@163.com.
authors.forename: Tao
authors.initials: T
authors.lastname: Sui
authors.affiliation: Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China. xiaojiancao001@126.com.
authors.forename: Xiaojian
authors.initials: X
authors.lastname: Cao
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D059925:Anatomic Landmarks; D001843:Bone Cements / Q000627:therapeutic use*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D008159:Lumbar Vertebrae / Q000293:injuries / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000473:pathology* / Q000628:therapy*; D011237:Predictive Value of Tests; D011677:Punctures; D012737:Sex Factors; D016103:Spinal Fractures / Q000473:pathology* / Q000628:therapy*; D016896:Treatment Outcome; D054854:Vertebroplasty / Q000379:methods*; D055815:Young Adult
chemical_list: D001843:Bone Cements