Comparison of Two Puncture Approaches in Robot-Assisted Percutaneous Kyphoplasty for Upper Thoracic Osteoporotic...

This study aimed to compare the clinical efficacy and safety of the robot-assisted trans-costotransverse joint approach and transpedicular approach in the treatment of upper thoracic single-segment osteoporotic vertebral compression fractures (OVCFs).

The data of 60 patients who underwent robot-assisted percutaneous kyphoplasty (PKP) from October 2023 to January 2025 were retrospectively analyzed. According to the different surgical approaches, they were divided into two groups: trans-costotransverse joint group (Group A n = 30) and transpedicular group (Group B n = 30). Perioperative indicators and clinical outcomes were compared.

The rate of satisfactory bone cement distribution was significantly higher in Group A than in Group B (90.0% vs. 66.7%, p = 0.028; OR = 4.50, 95% CI: 1.09-18.50), and the bone cement injection volume was greater (2.35 ± 0.34 mL vs. 2.13 ± 0.28 mL, p = 0.008), with mean difference (MD) = 0.22 mL (95% CI: 0.06-0.38 mL). The 1-year follow-up showed that the vertebral recollapse rate in Group A was significantly lower than that in Group B (3.3% vs. 20%, p = 0.044; OR = 0.14, 95% CI: 0.02-1.23). The incidence of bone cement leakage was lower in Group A than in Group B (6.7% vs. 26.7%, p = 0.038; OR = 0.20, 95% CI: 0.04-1.02). Although the VAS score, ODI indices, and local Cobb angle of the two groups were significantly improved compared with those before operation, there was no significant difference between the two groups.

In this retrospective analysis of patients with upper thoracic OVCF, robot-assisted trans-costotransverse joint PKP may result in a more favorable distribution of bone cement and improved short- to medium-term vertebral stability as compared with the transpedicular approach. This procedure shows acceptable safety profile, though further prospective studies are required to validate its clinical benefit.