Clinical Comparison On Treatment Of Osteoporotic Vertebral Compression Fractures Between Unipedicular Kyphoplasty And Bipedicular Kyphoplasty

Objective:The purpose of this study is to compare the clinical effects and differences on treatment of osteoporotic vertebral compression fractures between unipedicular and bipedicular kyphoplasty.Methods:Totally47patients with53symptomatic vertebrae of osteoporotic vertebral compression fractures operated by angioplasty convex vertebral from January2010to December2012at the Union Affiliated Hospital Of Fujian Medical University were retrospectively analyses.All of them received more than6months’follow-up.We divided47patients into two differents groups according to the operation was unilateral or bilateral approaches. The unilateral group included of12men with13vertebrates and11women with13vertebrates with an average age of71.9(range from49to89years old).Only one vertebrate was involved in19cases,two vertebrates were involved in4cases. The bilateral group included of6men with7vertebrates and18women with19vertebrates, with an average age of71.5(range from49to93years old). Only one vertebrate was involved in24cases,two vertebrates were involved in2cases. The fracture of vertebral body was from T7to L4, and it was confirmed that all cases were osteoporotic compression fractures by imaging studies preoperatively. Observation and analysis were conducted preoperatively and postoperatively. Observations included:surgical time, perspective times, visual analog pain score (VAS), recovery of height of vertebral bodies,spninal deformity correction,and bone cement leakage. Statistical data results were compared between these two groups.Results:All patients tolerated the operation well.The average surgical time was(58.33±14.48) min for unilateral group and the perspective times were (17.30±3.56). The VAS was reduced to (2.59±0.64) from(7.07±1.44) preoperatively, and was (2.85±1.06) after6 months’follow up. Cobb angle of unilateral group improved from (24.74±2.40)°to (11.63±1.45)°befor and after operation,and was (12.04±1.34)°at six months after operation.The mean height recoverd of the injured anterior vertebral body of unilateral group improved from (15.56±2.03) mm to (24.33±1.36) mm befor and after operation,and was (23.81±0.96) mm at six months after operation. The mean height recoverd of the injured medial vertebral body of unilateral group improved from(17.48±1.87)mm to(25.93±1.47)mm befor and after operation,and was (25.41±1.19)mm at six months after operation. The average surgical time was (78.08±15.75) min for bilateral group and the perspective times were(27.85±3.08). The VAS was reduced to (2.65±0.69) from (7.00±1.47) preoperatively, and was (2.92±0.80) after6months’follow up. Cobb angle of bilateral group improved from (24.97±2.58)°to (12.12±1.52)°befor and after operation,and was (12.46±1.45)°at six months after operation.The mean height recoverd of the injured anterior vertebral body of bilateral group improved from(15.42±1.92)mm to(24.27±1.51) mm befor and after operation,and was (23.81±1.20) mm at six months after operation. The mean height recoverd of the injured medial vertebral body of bilateral group improved from (17.50±1.92) mm to (25.81±1.52) mm befor and after operation,and was (25.17±1.28) mm at six months after operation. Compared with these two groups, the surgical time and the perspective times were statistical significance differences(P<0.05); the preoperative and postoperative of VAS,spinal deformity correction and the mean height recoverd of the anterior and medial vertebral bodies between these two groups were statistical significance differences(P<0.05), and the preoperative and the6months’follow-up were statistical significance differences(P<0.05). The recovery rate of VAS,spinal deformity correction and the mean height recoverd of the anterior and medial vertebral bodies between these two groups were no statistical significance differences(P>0.05). There was1case occured cement leakage in front of the vertebral body in the unilateral group, and there were lcase occurred cement leakage in front of the vertebral body and1case occured cement leakage beside the vertebral body in the bilateral group respectively. There was no case of pulmonary embolism, cerebral embolism, spinal cord or nerve root injury and other complications.Patients were followed up6～12months and9months on average. There is no aggravate pain in the operated vertebral body, no manifestation of delayed nerve injury, and no height loss of the operated vertebral body.Conclusion:Either unilateral or bilateral PKP could treat OVCFs efficiently.However there are some advanced in the unilateral puncture group,such as shorter operation time, less radiation exposure, less injury, and lower cost, so unipedicular approach percutaneous kyphoplasty is a practical and effective method in the treatment of osteoporotic vertebral compression fractures.