An anatomical study of lumbar unilateral transverse process-pedicle percutaneous vertebral augmentation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HU Pan , GUO Jun ,  WANG Hongwei , WU Deluo , XIANG Liangbi ,  CHEN Yu

Department of Orthopedics, General Hospital of Shenyang Military Area Command, Shenyang Liaoning, 110016, P.R.China;

Corresponding?author：

WANG Hongwei, Email: cplawhw@163.com; CHEN Yu, Email: chenyumd@126.com

Keywords：

Lumbar; anatomical parameter; percutaneous vertebral augmentation; approach

DOI：

10.7507/1002-1892.201705089

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Objective To measure the anatomical parameters related to lumbar unilateral transverse process-pedicle percutaneous vertebral augmentation, and to assess the feasibility and safety of the approach. Methods A total of 300 lumbar vertebral bodies of 60 patients were randomly selected, and vertebral augmentation were simulated 600 times on X-ray and CT image with unilateral conventional transpedicle approach (control group) and unilateral transverse process-pedicle approach (experimental group). The distance between the entry point and the midline of the vertebral body, the puncture inner inclination angle, the safe range of the puncture inner inclination angle, and the puncture success rate were measured and compared between the left and right with the same approach, and between the two approaches. Results The distance between the entry point and the midline gradually increased from L₁ to L₅ on both sides in the 2 groups. In the control group, the right sides distance of L₁ and L₂ was much longer than the left sides, and the right sides distance of L₁, L₂, and L₅ was much longer than the left sides in the experimental group (P<0.05); the distance of the experimental group between the entry point and the midline was much longer than the control group regardless of the sides from L₁ to L₅ (P<0.05). In the experimental group, the right maximum inner inclination angle from L₁ to L₅, the right middle inner inclination angle from L₁ to L₅, and the right minimum inner inclination angle from L₁, L₂, L₄, L₅ were significantly larger than the left side (P<0.05). The maximum inner inclination angle and the middle inner inclination angle presented increased tendency, the tendency of minimum inner inclination angle was ambiguous, however, the all inner inclination angles were much larger than those in control group among the different lumbar levels(P<0.05). There was no significant difference of the safe range of the puncture inner inclination angle between 2 sides in 2 groups at L₁ to L₅ (P<0.05); the safe range angle in experimental group at L₅ was significantly smaller than that in control group (P<0.05). The difference in total puncture success rate of all lumbar levels was significant between the experimental group and the control group (χ²=172.252, P=0.000); the puncture success rates of the experimental group were higher than those in the control group form L₁ to L₄ (P<0.05), but no significant difference was found in the puncture success rate between 2 groups at L₅ (P>0.05). Conclusion Compared with the unilateral conventional transpedicle approach, the entry point of the unilateral transverse process-pedicle approach is localized outside, the puncture inclination angle is wider, and the puncture success rate is higher. It shows that the unilateral transverse process-pedicle approach is safer and more reliable than the unilateral conventional transpedicle approach.

Citation： HU Pan, GUO Jun, WANG Hongwei, WU Deluo, XIANG Liangbi, CHEN Yu. An anatomical study of lumbar unilateral transverse process-pedicle percutaneous vertebral augmentation. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(11): 1346-1353. doi: 10.7507/1002-1892.201705089 Copy

1.	Lieberman IH, Dudeney S, Reinhardt MK, et al. Initial outcome and efficacy of " kyphoplasty” in the treatment of painful osteoporotic vertebral compression fractures. Spine (Phila Pa 1976), 2001, 26(14): 1631-1638.
2.	Rebolledo BJ, Gladnick BP, Unnanuntana A, et al. Comparison of unipedicular and bipedicular balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures: a prospective randomised study. Bone Joint J, 2013, 95-B(3): 401-406.
3.	Chen C, Chen L, Gu Y, et al. Kyphoplasty for chronic painful osteoporotic vertebral compression fractures via unipedicular versus bipedicular approachment: a comparative study in early stage. Injury, 2010, 41(4): 356-359.
4.	Huang Z, Wan S, Ning L, et al. Is unilateral kyphoplasty as effective and safeas bilateral kyphoplasties for osteoporotic vertebral compression fractures? A meta-analysis. Clin Orthop Relat Res, 2014, 472(9): 2833-2842.
5.	Chen B, Li Y, Xie D, et al. Comparison of unipedicular and bipedicular kyphoplasty on the stiffness and biomechanical balance of compression fractured vertebrae. Eur Spine J, 2011, 20(8): 1272-1280.
6.	Kobayashi K, Takizawa K, Koyama M, et al. Unilateral transpedicular percutaneous vertebroplasty using puncture simulation. Radiat Med, 2006, 24(3): 187-194.
7.	Kim AK, Jensen ME, Dion JE, et al. Unilateral transpedicular percutaneous vertebroplasty: initial experience. Radiology, 2002, 222(3): 737-741.
8.	Sakaino S, Takizawa K, Yoshimatsu M, et al. Percutaneous vertebroplasty performed by the isocenter puncture method. Radiat Med, 2008, 26(2): 70-75.
9.	王松, 王清, 康建平, 等. 經橫突-椎弓根單側穿刺椎體后凸成形術治療胸腰椎骨質疏松性壓縮骨折. 中國脊柱脊髓雜志, 2012, 22(7): 622-627.
10.	Wang S, Wang Q, Kang J, et al. An imaging anatomical study on percutaneous kyphoplasty for lumbar via a unilateral transverse process-pedicle approach. Spine (Phila Pa 1976), 2014, 39(9): 701-706.
11.	Steinmann J, Tingey CT, Cruz G, et al. Biomechanical comparison of unipedicular versus bipedicular kyphoplasty. Spine (Phila Pa 1976), 2005, 30(2): 201-205.
12.	Sun H, Lu PP, Liu YJ, et al. Can Unilateral Kyphoplasty Replace Bilateral Kyphoplasty in Treatment of Osteoporotic Vertebral Compression Fractures? A Systematic Review and Meta-analysis. Pain Physician, 2016, 19(8): 551-563.
13.	Feng H, Huang P, Zhang X, et al. Unilateral versus bilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures: A systematic review and meta-analysis of RCTs. J Orthop Res, 2015, 33(11): 1713-1723.
14.	Liebschner MA, Rosenberg WS, Keaveny TM. Effects of bone cement volume and distribution on vertebral stiffness after vertebroplasty. Spine (Phila Pa 1976), 2001, 26(14): 1547-1554.
15.	Knavel EM, Rad AE, Thielen KR, et al. Clinical outcomes withhemivertebral filling during percutaneous vertebroplasty. AJNR Am J Neuroradiol, 2009, 30(3): 496-499.
16.	Yan L, Jiang R, He B, et al. A comparison between unilateral transverse process-pedicle and bilateral puncture techniques in percutaneous kyphoplasty. Spine (Phila Pa 1976), 2014, 39(26 Spec No.): B19-26.
17.	Yan L, He B, Guo H, et al. The prospective self-controlled study ofunilateral transverse process-pedicle and bilateral puncture techniques in percutaneous kyphoplasty. Osteoporos Int, 2016, 27(5): 1849-1855.
18.	Li H, Yang L, Tang J, et al. An MRI-based feasibility study of unilateral percutaneous vertebroplasty. BMC Musculoskelet Disord, 2015, 16: 162.

1. Lieberman IH, Dudeney S, Reinhardt MK, et al. Initial outcome and efficacy of " kyphoplasty” in the treatment of painful osteoporotic vertebral compression fractures. Spine (Phila Pa 1976), 2001, 26(14): 1631-1638.
2. Rebolledo BJ, Gladnick BP, Unnanuntana A, et al. Comparison of unipedicular and bipedicular balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures: a prospective randomised study. Bone Joint J, 2013, 95-B(3): 401-406.
3. Chen C, Chen L, Gu Y, et al. Kyphoplasty for chronic painful osteoporotic vertebral compression fractures via unipedicular versus bipedicular approachment: a comparative study in early stage. Injury, 2010, 41(4): 356-359.
4. Huang Z, Wan S, Ning L, et al. Is unilateral kyphoplasty as effective and safeas bilateral kyphoplasties for osteoporotic vertebral compression fractures? A meta-analysis. Clin Orthop Relat Res, 2014, 472(9): 2833-2842.
5. Chen B, Li Y, Xie D, et al. Comparison of unipedicular and bipedicular kyphoplasty on the stiffness and biomechanical balance of compression fractured vertebrae. Eur Spine J, 2011, 20(8): 1272-1280.
6. Kobayashi K, Takizawa K, Koyama M, et al. Unilateral transpedicular percutaneous vertebroplasty using puncture simulation. Radiat Med, 2006, 24(3): 187-194.
7. Kim AK, Jensen ME, Dion JE, et al. Unilateral transpedicular percutaneous vertebroplasty: initial experience. Radiology, 2002, 222(3): 737-741.
8. Sakaino S, Takizawa K, Yoshimatsu M, et al. Percutaneous vertebroplasty performed by the isocenter puncture method. Radiat Med, 2008, 26(2): 70-75.
9. 王松, 王清, 康建平, 等. 經橫突-椎弓根單側穿刺椎體后凸成形術治療胸腰椎骨質疏松性壓縮骨折. 中國脊柱脊髓雜志, 2012, 22(7): 622-627.
10. Wang S, Wang Q, Kang J, et al. An imaging anatomical study on percutaneous kyphoplasty for lumbar via a unilateral transverse process-pedicle approach. Spine (Phila Pa 1976), 2014, 39(9): 701-706.
11. Steinmann J, Tingey CT, Cruz G, et al. Biomechanical comparison of unipedicular versus bipedicular kyphoplasty. Spine (Phila Pa 1976), 2005, 30(2): 201-205.
12. Sun H, Lu PP, Liu YJ, et al. Can Unilateral Kyphoplasty Replace Bilateral Kyphoplasty in Treatment of Osteoporotic Vertebral Compression Fractures? A Systematic Review and Meta-analysis. Pain Physician, 2016, 19(8): 551-563.
13. Feng H, Huang P, Zhang X, et al. Unilateral versus bilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures: A systematic review and meta-analysis of RCTs. J Orthop Res, 2015, 33(11): 1713-1723.
14. Liebschner MA, Rosenberg WS, Keaveny TM. Effects of bone cement volume and distribution on vertebral stiffness after vertebroplasty. Spine (Phila Pa 1976), 2001, 26(14): 1547-1554.
15. Knavel EM, Rad AE, Thielen KR, et al. Clinical outcomes withhemivertebral filling during percutaneous vertebroplasty. AJNR Am J Neuroradiol, 2009, 30(3): 496-499.
16. Yan L, Jiang R, He B, et al. A comparison between unilateral transverse process-pedicle and bilateral puncture techniques in percutaneous kyphoplasty. Spine (Phila Pa 1976), 2014, 39(26 Spec No.): B19-26.
17. Yan L, He B, Guo H, et al. The prospective self-controlled study ofunilateral transverse process-pedicle and bilateral puncture techniques in percutaneous kyphoplasty. Osteoporos Int, 2016, 27(5): 1849-1855.
18. Li H, Yang L, Tang J, et al. An MRI-based feasibility study of unilateral percutaneous vertebroplasty. BMC Musculoskelet Disord, 2015, 16: 162.

Chinese Journal of Reparative and Reconstructive Surgery

An anatomical study of lumbar unilateral transverse process-pedicle percutaneous vertebral augmentation

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