[Unilateral superior transverse process-extrapedicular approach vertebroplasty for osteoporotic lumbar fractures with...

To evaluate the efficacy and safety of unilateral transtransverse process superior border pedicle external approach vertebral body reconstruction for lumbar fractures associated with osteoporosis in small pedicles.

A retrospective analysis was conducted on 13 patients with vertebral fractures accompanied by osteoporotic microarches who underwent unilateral transluminal pedicle approach vertebral body reconstruction between October 2021 and March 2024, including 5 males and 8 females, with an average age of (72.92±5.95) ranging from 65 to 85 years old. The cases included 9 L₁ fractures and 4 L₂ fractures, all with a history of low-energy trauma characterized by lower back pain exacerbated upon sitting up and radiating to both costal regions in 4 cases. The disease duration ranged from 1 to 5 days with a mean of (2.92±1.19) days. Preoperative visual analogue scale (VAS) ranged from 5 to 7 with a mean of (6.31±0.75). MRI findings indicated fresh fractures with bone mineral density T-values <-2.5;axial CT measurements revealed pedicle diameters at their narrowest point ranging from 4.2 to 4.7 mm with a mean of (4.42±0.17) mm, all <5 mm. Individualized puncture planning was performed preoperatively, including measurement of skin-puncture distance on CT cross-sections and head-side deviation distance on lateral X-rays for precise intraoperative positioning. Surgical parameters including operative time, number of fluoroscopic procedures, bone cement volume injected, cement dispersion, and complications were recorded. Efficacy was assessed using VAS and the Oswestry disability index (ODI) at preoperative, postoperative day 1, and postoperative 3-month follow-up.

All patients underwent the surgery successfully and received follow-up examinations ranging from 3 months to 1 year. The operative duration ranged from 35 to 46 with a mean of (40.15±3.34) minutes. The number of fluoroscopic procedures was 11 to 17 with a mean of (13.77±2.05). The bone cement volume injected ranged from 4 to 6 with a mean of (4.73±0.70) mL, achieving uniform bilateral distribution throughout the bone cement. One case exhibited asymptomatic intervertebral space cement leakage, with no complications such as nerve injury or hematoma observed. Both VAS and ODI at 1 day and 3 months postoperatively were significantly lower than preoperative levels (P<0.05), with better outcomes at 3 months compared to 1 day (P<0.05).

For osteoporotic lumbar fractures with narrow pedicles, unilateral percutaneous vertebral body formation via an extra-pedicular approach via the superior border of the transverse process is a technically feasible and highly effective treatment modality, offering advantages including shorter operative time, enhanced safety, reduced fluoroscopic requirements, and minimal invasiveness.