Hidden blood loss of percutaneous vertebroplasty for osteoporotic vertebral compression fractures

The aim of this study was to evaluate the amount of hidden blood loss (HBL) in patients treated with percutaneous vertebroplasty (PVP) for thoracolumbar osteoporotic vertebral compression fractures (OVCFs) and to compare the HBL between unilateral extrapedicular approach and unilateral transpedicular approach.

Between February 2022 to February 2023, a total of 136 patients (49 males, 87 females; mean age: 76.4±9.5 years; range, 55 to 100 years) with thoracolumbar OVCFs treated with PVP were retrospectively analyzed. Patients who underwent unilateral transpedicular approach were divided into Group A (n=62) and patients who underwent unilateral extrapedicular approach were divided into Group B (n=74). Demographic results and clinical data were collected and compared between the two groups. The HBL was calculated according to the Sehat formula.

The mean operation duration was 31.7±9.9 min in Group A and 29.1±11.1 in Group B, indicating no statistically significant difference between the groups (p=0.159). The mean volume of bone cement instilled was 4.4±0.4 mL in Group A and 4.7±0.6 mL in Group B. The volume of cement injected in Group A was less than that of Group B (p=0.001). The mean hemoglobin loss and the amount of HBL were significantly lower in Group A than Group B (p=0.001 and p=0.040, respectively).

Our study results suggest that perioperative HBL cannot be ignored in PVP for thoracolumbar OVCFs, regardless of the surgical approach chosen. We should be more concerned about anemia in patients with thoracolumbar OVCFs after unilateral extrapedicular approach compared to the unilateral transpedicular approach.