J Korean Soc Spine Surg.  2011 Dec;18(4):195-201. 10.4184/jkss.2011.18.4.195.

The Usefulness and Technique of Unilateral Extrapedicular Approach in Vertebroplasty

• Ahn SJ
• Kim BH
• Song MH
• Yoo SH
• Lee DJ

• KMID: 1447996
• DOI: http://doi.org/10.4184/jkss.2011.18.4.195

Abstract

STUDY DESIGN: A retrospective study.
OBJECTIVES
To evaluate the effectiveness of unilateral extrapedicular approach in the treatment of osteoporotic compression fracture, as compared to transbipedicular approach. SUMMARY OF LITERATURE REVIEW: There has been no comparative study assessing this topic.
MATERIALS AND METHODS
115 patients presenting with percutaneous vertebroplasty between Mar. 2002 and Feb. 2009, were divided into three groups: Group A (43 vertebrae; 29 patients) who were treated with bipedicular approach, Group B (66 vertebrae; 47 patients) treated with early cases of unilateral extrapedicular approach, and Group C (43 vertebrae; 39 patients) treated with late cases of unilateral extrapedicular approach. We analyzed radiological test results including the volume of injected cement and the distribution of intravertebral body, cement leakage, height restoration and kyphosis correction. Statistical analysis was done using SPSS. Clinical results were analyzed using VAS scores.
RESULTS
The mean follow-up period varied from one year at minimum to seven years and six months at maximum. The mean volume of injected cement was 3.39cc/5.39cc/3.79cc for groups A, B and C respectively. Cement leakage was at 13.4/34.8/12.8% in each group. Cement leakage was higher in group B, but most leakage took place in early cases that we tried to inject more and more cement in early inexperienced period. Bilaterally well distributed cement in the vertebral body was at 85.7/76.9% in groups B and C respectively. VAS scores improved from 8.4/8.3/8.5 preoperatively to 2.0/2.0/1.6 postoperatively.
CONCLUSIONS
Percutaneous vertebroplasty treated with unilateral extrapedicular approach can lessen perioperative operating time. This treatment led to clinical and radiologic results that were comparable to those with a bilateral transpedicular approach.

Keyword

Osteoporotic compression fracture; Vertebroplasty; Unilateral extrapedicular approach; Transbipeducular approach

MeSH Terms

Follow-Up Studies
Fractures, Compression
Humans
Hypogonadism
Kyphosis
Mitochondrial Diseases
Ophthalmoplegia
Retrospective Studies
Vertebroplasty
Hypogonadism
Mitochondrial Diseases
Ophthalmoplegia

Figure

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  Fig. 1. (A) Entry Point: in the AP spot, just lateral 0.5-1cm superolateral to vertebral body. in the lateral spot, needle should be located at junction of transverse process and facet joint or rib.(B) Needle should be inserted with appropriate convergency. Proper convergency is that needle tip is located at medial wall of pedicle in the AP spot. And 5mm anterior to posterior sagittal line in the lateral spot. (C) Recommandable final needle position is closer to midline of vertebral body in the AP spot. and anterior 3/4 of body in the lateral spot. (D) The postoperative plain film shows successful cement injection with bilateral distribution evenly.

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