Percutaneous vertebroplasty via unilateral approach guided by preoperative CT imaging in the treatment of osteoporotic vertebral compression fractures
Authors: Zhao Xue-quan , Han Xixi , LI Chenxu , Liu Qinglei , Yao Shuzhang 
Published: September 2023

Abstract
Background:Percutaneous vertebroplasty（PVP） has become one of the main methods for the treatment of osteoporotic vertebral compression fractures(OVCF).percutaneous vertebroplasty with unilateral approach was usually adopted by surgeons for better clinical outcome. however,This program can, in turn, be queried for its Longer operation time and Financial burden on patients.
Objective: We investigated in a path planning to efficiently locate needle injection points reaching the target volume by unilateral approach without puncturing risk structures.To explore the feasibility and clinical outcomes of percutaneous vertebroplasty via a unilateral extrapedicular approach under the guidance of preoperative CT imaging in the treatment of OVCF.
Methods: One hundred and ninety-three patients with symptomatic OVCF treated with PVP were retrospectively reviewed in a single institution.Patients were divided into Group A(unilateral extrapedicular approach under the guidance of preoperative CT imaging) and Group B(bilateral approach), based on operative approach. The efficacy was evaluated by perioperative indicators, follow-up results and imaging evaluation.All computations were performed with standard software (SPSS version 22.0 for Windows; IBM).
Results：One hundred and sixtyty-nine of 193 eligible patients were included. All the patients received the follow-up visits for 49-70 months.In this case, there were no serious postoperative complications.A significant difference was found between group A and group B in terms of operation time，puncture time，amount of bone cement injected，the number of X-ray fluoroscopy (P < 0.05). the difference in the incidence of cement leakage between the two groups was not statistically significant (P > 0.05)，and the length of hospitalization and hospital costs in group A were lower than those in group B was not statistically significant (P > 0.05).The time of postoperative mobilization was(11.00 ± 0.80)hours in group A and(13.60 ± 0.79)hours in group B，The difference was statistically significant (P < 0.05).As VAS and ODI scores, the short-term efficacy of the group A was worse than that of the group B, but the difference between the two groups was smaller at the final follow-up(P > 0.05). In terms of imaging evaluation, there were no significant differences between the two groups(P > 0.05).
Conclusions: All patients were assessable for safety and efficacy. At the final follow-up, both groups showed significant improvements in the height of the height of the vertebral body and Cobb's angle of kyphosis (P < 0.05).Changes in VAS after PVP, the preoperative pain reduced significantly.The guidance of preoperative CT imaging assisted opreation resulted in less blood loss intraoperatively, a shorter operation time, and less number of fluoroscopy(P > 0.05), This technique is worth promoting and has the potential to accelerate patient rehabilitation and reduce hospitalization costs in patients.