Enhancing precision in percutaneous vertebroplasty: a study on patient-specific 3D-printed guides for osteoporotic...

The aim of this study was to investigate the safety and feasibility of 3D-printed puncture guides assisting in unilateral-approach percutaneous vertebroplasty (PVP) for the treatment of osteoporotic vertebral compression fractures (OVCFs).

We retrospectively analyzed the medical records of 106 patients admitted to the Department of Spine Surgery of the Affiliated Hospital of Yan'an University who underwent PVP with a unilateral approach from June 2020 to June 2022, and divided them into 2 groups based on the use of 3D-printed perforation guides during the operation: 52 patients in the 3D-printed perforation guide-assisted PVP group (Observation group), and 54 patients in the traditional PVP group (Control group). The general information, operation time, puncture time, number of intraoperative C-arm fluoroscopies, amount of bone cement injected, postoperative complications, pedicle wall breaches by the puncture needle trajectory, and the degree of compression of the anterior margin of the vertebral body and the Cobb's angle, which were measured on the lateral views of the injured vertebrae preoperatively and postoperatively, were recorded and compared between the two groups. A visual analogue scale (VAS) was used to evaluate the degree of pain in the injured vertebral region, and the Oswestry Disability Index (ODI) was used to assess the degree of functional disability of the patients.

(1) There were no statistically significant differences between the two groups regarding gender, age, body mass index (BMI), bone mineral density (BMD), injured segment, and other baseline characteristics (P > 0.05). (2) The operation time, intraoperative puncture time, and cement leakage rate in the observation group were lower than those in the control group (P < 0.05). Furthermore, the incidence of nerve root injury, whole-cement displacement, contralateral diffusion, and puncture paths breaching the pedicle walls was significantly lower in the observation group compared to the control group (P < 0.05). (3) The degree of vertebral anterior compression in the observation group at 1 day postoperatively [(21.01 ± 1.98)%] was significantly lower than that in the control group [(23.21 ± 2.47)%] (P < 0.05). (4) There were no statistically significant differences in the amount of bone cement injected or the incidence of adjacent vertebral fractures between the two groups (P > 0.05). (5) There was no statistically significant difference in the comparison of the VAS scores and ODI scores of the two groups in the postoperative period and during the postoperative follow-up period (P > 0.05).

3D-printed puncture guide-assisted unilateral approach PVP for the treatment of single-segment OVCFs has significant clinical advantages compared with the traditional unarmed puncture group. Specifically, it improves the ratio of overall to contralateral bone cement dispersion volume, significantly enhances puncture accuracy, and reduces the incidence of surgical complications. It also reduces the number of fluoroscopies, shortens the operative time, and comprehensively improves surgical safety and operational efficiency.