Precise puncture combined with simplified percutaneous vertebroplasty to treat osteoporotic vertebral compression fractures: a comparative analysis with conventional percutaneous vertebroplasty.

OBJECTIVE: To investigate the feasibility and clinical efficacy of precise puncture combined with simplified percutaneous vertebroplasty (PVP) for treating osteoporotic vertebral compression fractures (OVCF). METHODS: A total of 82 patients with single-segment osteoporotic vertebral compression fractures (OVCF) treated with PVP from Dec. 2016 to Nov. 2018 were retrospectively analyzed. Among the patients, 45 cases in group A accepted precise puncture combined with simplified PVP, and 37 cases in group B underwent conventional PVP. The operative time, the number of intraoperative fluoroscopy, vertebral height restoration, postoperative bone cement distribution and bone cement leakage were observed and compared. The pain relief and improvement of quality of life (QOL) were assessed by visual analog score (VAS) and Oswestry disability index (ODI). RESULTS: There were no differences in injected cement volume and hospital stays in group A versus group B. The operative time, the number of intraoperative fluoroscopy and material cost were lower in group A compared with group B (P<0.05). After surgery, the VAS scores, ODI, the average vertebral height and Cobb angle were obviously improved and they were significantly different from those before operation (P<0.05). There was no statistically significant difference for VAS scores, ODI, average vertebral height and Cobb angle between groups at different time points. The proportion of patients with bone cement dispersion exceeding the midline of vertebra in group A was significantly higher than that in group B (82.2% vs. 62.1%, P<0.05), whereas the bone cement leakage rate in group A was lower than that in group B (8.9% vs. 27.0%, P<0.05). Patients were followed-up for 12-23 months (mean 17.6 months) after surgery. There were 3 cases (6.6%) of adjacent vertebral fractures in group A and 2 cases (5.4%) in group B. CONCLUSION: Precise puncture can improve the accuracy of puncture needle through pedicle to vertebral body. It is conducive to obtaining a better diffusion of bone cement across the midline with a lower bone cement leakage rate. Simplified PVP can not only reduce the surgery procedures, shorten the operative time, reduce the X-ray frequency, but also save material cost.