Preoperative Planning of the Lateral Entry Point Is Necessary in Percutaneous L5 Vertebroplasty

To compare treatment outcomes and complications between the computer-assisted preoperative planning of lateral entry approach and the traditional approach for L5 percutaneous vertebroplasty.

In this prospective randomized clinical study performed from January 2008 to December 2014, 68 patients scheduled for L5 percutaneous vertebroplasty were divided at random into group A, in which the traditional transpedicle approach was used, and group B, in which the computer-assisted lateral entry point approach was used. A visual analog scale and Oswestry Disability Index were evaluated preoperatively, postoperatively, and at the latest follow-up.

Patient demographics were similar in the 2 groups. The mean duration of follow-up was 65 months. The mean distance between the entry point and the midline was 3.05 ± 0.5 cm in group A and 7.04 ± 0.7 cm in group B. The mean inclination angle measured on the preoperative axial image was 17.1 ± 3.4° in group A and 41 ± 3.8° in group B. Clinical outcomes were comparable in the 2 groups; however, cement leakage was significantly greater in group A (P < 0.001).

Owing to the hemispherical morphology and convergent pedicle axis of the L5 vertebrae, a more lateral skin entry point and convergent angle of the puncture needle should be emphasized to reach the optimal point according to the preoperative assessment. The approach involving computer-assisted preoperative planning of the lateral entry point was associated with a higher rate of bilateral cement infiltration with fewer complications.