Effect Of Percutaneous Vertebrosplasty By Unilateral Transverse Process Approach Combined With Postural Reduction For Severe Lumbar Osteoporotic Vertebral Compression Fracture

Objective:To explore the clinical efficacy of percutaneous vertebroplasty (PVP) by unilateral transverse process approach combined with postural reduction in the treatment of Severe lumbar osteoporotic vertebral compression fracture (OVCF).Methods:A retrospectively analysis was carried out for 45 cases with Severe lumbar osteoporotic vertebral compression fracture admitted in our department from March 2012 to July 2014. All patients underwent PVP by unilateral transverse process pedicle approach combined with postural reduction. There were 45 vertebrae(11 males and 34 females), with their ages ranging from 60 to 93 years old (average age: 74.38).Visual analogue scale (VAS) scores, Oswestry disability indexes (ODI), Cobb angles, and heights of posterior and middle injured vertebrae of these patients were compared operation, three days postoperation and at the final follow-up. The clinical effects were also evaluated.Results:All patients successfully completed the surgery. The length of surgery was 29.84±7.73 minutes, and the amount of PMMA was 5.1±0.97 ml. A total of 7 cases (15.6%) suffered from bone cement leakage and showed no relevant clinical symptoms and signs.39 cases obtained satisfactory follow-ups, the duration of follow-up was 6 to 30 months (mean duration:18.2 months), and 6 cases were lost to follow-up (13.3%). Three days postoperation, VAS score was 2.28±0.89 points, ODI was 33.95±4.44%, Cobb Angle was±1.69°, the heights of posterior and middle injured vertebrae were 24.82±2.52 mm and 24.82±2.06 mm respectively. At the final follow-up, VAS score was 1.73±0.76, ODI was 21.33±4.83%, Cobb Angle was 8.44±1.65°, and the heights of posterior and middle injured vertebrae were 23.92±2.34mm and 22.07±2.18mm. VAS scores and ODI differed before operation, three days postoperation and at the final follow-up, showing statistically significant differences (P < 0.05). The Cobb angles and heights of posterior and middle vertebrae postoperation were much better than preoperation (P<0.05). There were no obvious changes in the lumbar Cobb angles and heights of posterior and middle vertebrae between the final follow-up and three days postoperation (P>0.05).Conclusions:PVP by unilateral transverse process approach combined with postural reduction is a safe, simple, effective and economic surgical option because it can effectively relieve pain caused by Severe lumbar osteoporotic vertebral compression fracture, restore and maintain the height of injured vertebrae, correct Cobb angle, reestablish lumbar sagittal balance, and greatly improve quality of life.