[Application of percutaneous vertebro-pedicle plasty in osteoporotic vertebral compression fractures]

To explore the clinical efficacy of percutaneous vertebro-pediculoplasty(PVPP) versus traditional percutaneous vertebroplasty(PVP) in the treatment of osteoporotic vertebral compression fractures (OVCF) of the thoracolumbar spine.

A retrospective analysis was performed on 87 OVCF patients admitted from January 2020 to January 2023. They were divided into the PVPP group (40 cases) and PVP group (47 cases) according to the surgical method. The PVPP group included 5 males and 35 females,aged from 61 to 82 years with an average of (77.91±6.83) years,body mass index (BMI) of (23.89±3.10) kg·m^-2,bone mineral density T-value of (-3.13±0.57),and disease course of (11.53±4.16) days. The PVP group included 7 males and 40 females,aged from 62 to 83 years with an average of (75.58±7.35) years,BMI of (23.52±2.84) kg·m^-2,bone mineral density T-value of (-3.21±0.65),and disease course of (10.25±3.57) days. Perioperative indicators,visual analogue scale (VAS),Oswestry disability index (ODI),anterior vertebral height,Cobb angle of the injured vertebra,and complication rate were observed and compared between two groups.

All patients were followed up,with a follow-up period of (13.85±2.01) months in the PVPP group and (14.16±2.74) months in the PVP group. The operation time of the PVPP group was (45.61±8.33) minutes,which was longer than that of the PVP group (38.25±7.18) minutes,with a statistically significant difference (P<0.001). The bone cement injection volume of the PVPP group was (4.98±0.96) ml,which was higher than that of the PVP group(3.91±0.82) ml,with a statistically significant difference (P<0.05). The VAS of both groups at 1 day,3 months,and 1 year after operation were improved compared with those before operation(F_time=528.47,P<0.001;F_group=12.76,P=0.001;F_interaction=3.24,P=0.022). The ODI percentages of both groups at 1 day,3 months,and 1 year after operation were significantly improved compared with those before operation (P<0.05),and the ODI percentages of the PVPP group at 3 months and 1 year after operation were lower than those of the PVP group (P<0.05). The anterior vertebral height of both groups at 1 day,3 months,and 1 year after operation was significantly restored compared with that before operation (P<0.05);there was a statistically significant difference in the loss rate of anterior vertebral height between two groups (P<0.001). The Cobb angles of both groups at 1 day,3 months,and 1 year after operation were significantly smaller than those before operation (P<0.05);there were statistically significant differences in the Cobb angles between the two groups at 3 months and 1 year after operation (P<0.001). PVPP was significantly superior to PVP in height maintenance (F=15.27,P<0.001) and angle control (F=12.83,P<0.001). The refracture rate of the affected vertebra in the PVPP group was 2.50%(1/40),and the fracture rate of adjacent vertebrae was 5.00%(2/40),which were significantly lower than those in the PVP group [14.89% (7/47) and 17.02%(8/47)],with statistically significant differences (P<0.05).

PVPP is superior to PVP in long-term pain control,maintenance of vertebral stability,and reduction of refracture risk. It is especially suitable for patients with pedicle microfractures or high osteoporosis risk,providing a more optimized minimally invasive strategy for the treatment of OVCF.