Unipedicular vertebroplasty for osteoporotic compression fracture using an individualized needle insertion angle

Area of Science:

• Orthopedic Surgery
• Neurosurgery
• Radiology

Background:

• Traditional transpedicular vertebroplasty often requires a second needle insertion.
• Individualized needle insertion angles (NIA) are crucial for precise placement in fractured vertebrae.
• Axial magnetic resonance imaging (MRI) can aid in pre-procedural planning.

Purpose of the Study:

• To evaluate the safety and efficacy of a unipedicular approach for percutaneous vertebroplasty (PVP) using individualized NIA.
• To determine the success rate of cement filling in the vertebral body center using this technique.
• To assess the impact of the unipedicular approach on patient pain levels.

Main Methods:

• Performed PVP on 103 vertebrae in 63 patients using a unipedicular approach with pre-evaluated individualized NIA.
• Measured NIA using axial MRI before PVP.
• Converted to a bipedicular approach if cement leakage occurred without midline crossover.

Main Results:

• Successful unipedicular PVP, defined by central cement filling, was achieved in 90.3% (93/103) of cases.
• Significant pain reduction was observed, with Visual Analog Scale (VAS) scores decreasing from 84 preoperatively to 32 at 1 day, 34 at 1 month, and 37 at 3 months postoperatively (P<0.0001).
• No significant difference was found between pre- and post-procedure NIAs, with a positive correlation observed.

Conclusions:

• Unipedicular PVP using individualized NIA is a safe and effective technique.
• A thorough understanding of bony landmarks and pedicle anatomy is essential for successful implementation.
• The unipedicular approach can be considered as a primary option for PVP.