Unilateral Dual-Plane Puncture Percutaneous Vertebroplasty Reduces Re-Collapse in Osteoporotic Vertebral Compression Fractures by Advancing Cement Delivery

Abstract

Purpose: Evaluate the efficacy of a novel unilateral dual-plane puncture technique in improving bone cement distribution and reducing vertebral re-collapse following percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures (OVCFs). By introducing the novel unilateral dual-plane puncture technique, this study aims to improve cement distribution, reduce the incidence of re-collapse, and enhance long-term clinical outcomes for patients suffering from OVCFs.

Methods: This is a randomized trial conducted from April 2021 to December 2022, enrolling 145 patients diagnosed with OVCFs. Patients were allocated into either traditional or unilateral dual-plane puncture groups. Bone cement distribution, vertebral height, and segmental kyphotic angle were measured through postoperative x-ray, while clinical outcomes were evaluated using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI). Statistical analysis was performed using the Mann–Whitney U test and independent samples t test for continuous variables, and chi-square or Fisher's exact test for categorical variables.

Results: The unilateral dual-plane puncture technique notably augmented bone cement contact with both superior and inferior endplates compared to conventional methods, achieving rates of 64.86% versus 40.85% (p < 0.001). This contributed to a significant reduction in the incidence of vertebral re-collapse within the first year post-operation: 18.92% in the unilateral dual-plane group as opposed to 42.25% in the traditional group (p < 0.001). Furthermore, the unilateral dual-plane group exhibited markedly superior long-term efficacy, evidenced by mean VAS and ODI scores of 1.26 and 28.58, respectively, in comparison to 2.03 and 32.45 in the traditional group.

Conclusions: The unilateral dual-plane puncture technique advances bone cement distribution within the vertebra, thereby reducing the risk of vertebral re-collapse following PVP surgery and improving long-term clinical outcomes for patients with OVCFs.

Keywords

osteoporotic vertebral compression fractures / percutaneous vertebroplasty / re-collapse / unilateral dual-plane puncture

References

[1] V. Gopinath, “Osteoporosis,” Medical Clinics of North America 107, no. 2 (2023): 213-225.

[2] M. D. Walker and E. Shane, “Postmenopausal Osteoporosis,” New England Journal of Medicine 389, no. 21 (2023): 1979-1991.

[3] S. A. Sabri, J. C. Chavarria, C. Ackert-Bicknell, C. Swanson, and E. Burger, “Osteoporosis: An Update on Screening, Diagnosis, Evaluation, and Treatment,” Orthopedics 46, no. 1 (2023): e20-e26.

[4] F. Y. Kutsal and G. O. Ergin Ergani, “Vertebral Compression Fractures: Still an Unpredictable Aspect of Osteoporosis,” Turkish Journal of Medical Sciences 51, no. 2 (2021): 393-399.

[5] G. Porcu, A. Biffi, R. Ronco, et al., “Refracture Following Vertebral Fragility Fracture When Bone Fragility Is Not Recognized: Summarizing Findings From Comparator Arms of Randomized Clinical Trials,” Journal of Endocrinological Investigation 47, no. 4 (2024): 795-818.

[6] J. Ehresman, A. Schilling, X. Yang, et al., “Vertebral Bone Quality Score Predicts Fragility Fractures Independently of Bone Mineral Density,” Spine Journal 21, no. 1 (2021): 20-27.

[7] D. Patel, J. Liu, and N. A. Ebraheim, “Managements of Osteoporotic Vertebral Compression Fractures: A Narrative Review,” World Journal of Orthopedics 13, no. 6 (2022): 564-573.

[8] R. Gutierrez-Gonzalez, A. Royuela, and A. Zamarron, “Vertebral Compression Fractures: Pain Relief, Progression and New Fracture Rate Comparing Vertebral Augmentation With Brace,” BMC Musculoskeletal Disorders 24, no. 1 (2023): 898.

[9] O. Musbahi, A. M. Ali, H. Hassany, and R. Mobasheri, “Vertebral Compression Fractures,” British Journal of Hospital Medicine 79, no. 1 (2018): 36-40.

[10] S. Prost, S. Pesenti, S. Fuentes, P. Tropiano, and B. Blondel, “Treatment of Osteoporotic Vertebral Fractures,” Orthopaedics & Traumatology, Surgery & Research: OTSR 107, no. 1s (2021): 102779.

[11] J. McCarthy and A. Davis, “Diagnosis and Management of Vertebral Compression Fractures,” American Family Physician 94, no. 1 (2016): 44-50.

[12] Y. S. Park and H. S. Kim, “Prevention and Treatment of Multiple Osteoporotic Compression Fracture,” Asian Spine Journal 8, no. 3 (2014): 382-390.

[13] J. Li, L. Xu, Y. Liu, et al., “Open Surgical Treatments of Osteoporotic Vertebral Compression Fractures,” Orthopaedic Surgery 15, no. 11 (2023): 2743-2748.

[14] Y. Long, W. Yi, and D. Yang, “Advances in Vertebral Augmentation Systems for Osteoporotic Vertebral Compression Fractures,” Pain Research & Management 2020 (2020): 3947368.

[15] R. Buchbinder, R. V. Johnston, K. J. Rischin, et al., “Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fracture,” Cochrane Database of Systematic Reviews 4, no. 4 (2018): Cd006349.

[16] M. Stevenson, T. Gomersall, M. Lloyd Jones, et al., “Percutaneous Vertebroplasty and Percutaneous Balloon Kyphoplasty for the Treatment of Osteoporotic Vertebral Fractures: A Systematic Review and Cost-Effectiveness Analysis,” Health Technology Assessment (Winchester) 18, no. 17 (2014): 1-290.

[17] D. K. Filippiadis, S. Marcia, S. Masala, F. Deschamps, and A. Kelekis, “Percutaneous Vertebroplasty and Kyphoplasty: Current Status, New Developments and Old Controversies,” Cardiovascular and Interventional Radiology 40, no. 12 (2017): 1815-1823.

[18] Y. Sun, Y. Zhang, H. Ma, M. Tan, and Z. Zhang, “Therapeutic Efficacy and Safety of Percutaneous Curved Vertebroplasty in Osteoporotic Vertebral Compression Fractures: A Systematic Review and Meta-Analysis,” Orthopaedic Surgery 15, no. 10 (2023): 2492-2504.

[19] H. Wang, H. Yu, Y. Zhu, et al., “Unilateral Percutaneous Kyphoplasty Using a Novel Guide Device for Thoracolumbar Osteoporotic Vertebral Fracture,” Orthopaedic Surgery 15, no. 4 (2023): 993-1001.

[20] D. H. Heo, D. K. Chin, Y. S. Yoon, and S. U. Kuh, “Recollapse of Previous Vertebral Compression Fracture After Percutaneous Vertebroplasty,” Osteoporosis International: A Journal Established as Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 20, no. 3 (2009): 473-480.

[21] W. C. Lin, Y. C. Lee, C. H. Lee, et al., “Refractures in Cemented Vertebrae After Percutaneous Vertebroplasty: A Retrospective Analysis,” European Spine Journal: Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 17, no. 4 (2008): 592-599.

[22] L. Mo, Z. Wu, D. Liang, et al., “Influence of Bone Cement Distribution on Outcomes Following Percutaneous Vertebroplasty: A Retrospective Matched-Cohort Study,” Journal of International Medical Research 49, no. 7 (2021): 3000605211022287.

[23] D. Li, Y. Wu, Y. Huang, B. Augustine, and J. Yue, “Risk Factors of Recompression of Cemented Vertebrae After Kyphoplasty for Osteoporotic Vertebral Compression Fractures,” International Orthopaedics 40, no. 6 (2016): 1285-1290.

[24] M. Srivastava and C. Deal, “Osteoporosis in Elderly: Prevention and Treatment,” Clinics in Geriatric Medicine 18, no. 3 (2002): 529-555.

[25] I. R. Reid, “A Broader Strategy for Osteoporosis Interventions,” Nature Reviews Endocrinology 16, no. 6 (2020): 333-339.

[26] R. Eastell, T. W. O'Neill, L. C. Hofbauer, et al., “Postmenopausal Osteoporosis,” Nature Reviews Disease Primers 2, no. 1 (2016): 16069, https://doi.org/10.1038/nrdp.2016.69.

[27] Y. Wang, Y. Tao, M. E. Hyman, J. Li, and Y. Chen, “Osteoporosis in China,” Osteoporosis International: A Journal Established as Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 20, no. 10 (2009): 1651-1662.

[28] P. Chen, Z. Li, and Y. Hu, “Prevalence of Osteoporosis in China: A meta-Analysis and Systematic Review,” BMC Public Health 16, no. 1 (2016): 1039.

[29] D. H. Kim and A. R. Vaccaro, “Osteoporotic Compression Fractures of the Spine; Current Options and Considerations for Treatment,” Spine Journal 6, no. 5 (2006): 479-487.

[30] Z. Wang, H. Wang, C. Zhuang, et al., “The Effect of Type 2 Diabetes Mellitus on the Prognosis of Osteoporotic Vertebral Compression Fracture With Osteoporotic Fracture Classification After Vertebroplasty,” Journal of Orthopaedic Surgery and Research 18, no. 1 (2023): 342.

[31] M. Mazzantini, A. Figliomeni, V. Bottai, et al., “High Rate of Vertebral Refracture After Vertebroplasty in Patients Taking Glucocorticoids: A Prospective Two-Year Study,” Clinical and Experimental Rheumatology 38, no. 4 (2020): 649-653.

[32] D. Martinčič, M. Brojan, F. Kosel, et al., “Minimum Cement Volume for Vertebroplasty,” International Orthopaedics 39, no. 4 (2015): 727-733.

[33] Y. X. Li, D. Q. Guo, S. C. Zhang, et al., “Risk Factor Analysis for Re-Collapse of Cemented Vertebrae After Percutaneous Vertebroplasty (PVP) or Percutaneous Kyphoplasty (PKP),” International Orthopaedics 42, no. 9 (2018): 2131-2139.

[34] H. B. Sun, X. S. Jing, J. L. Shan, L. Bao, D. C. Wang, and H. Tang, “Risk Factors for Pulmonary Cement Embolism Associated With Percutaneous Vertebral Augmentation: A Systematic Review and meta-Analysis,” International Journal of Surgery (London, England) 101 (2022): 106632.

[35] Y. Chevalier, D. Pahr, M. Charlebois, P. Heini, E. Schneider, and P. Zysset, “Cement Distribution, Volume, and Compliance in Vertebroplasty: Some Answers From an Anatomy-Based Nonlinear Finite Element Study,” Spine 33, no. 16 (2008): 1722-1730.

[36] S. Yang, C. Chen, H. Wang, Z. Wu, and L. Liu, “A Systematic Review of Unilateral Versus Bilateral Percutaneous Vertebroplasty/Percutaneous Kyphoplasty for Osteoporotic Vertebral Compression Fractures,” Acta Orthopaedica et Traumatologica Turcica 51, no. 4 (2017): 290-297.

[37] F. Zhang, Q. M. Zhao, X. H. Ni, et al., “Comparison of Unilateral and Bilateral Puncture Percutaneous Kyphoplasty in the Treatment of Osteoporotic Vertebral Compression Fractures,” Neurosciences (Riyadh, Saudi Arabia) 26, no. 3 (2021): 236-241.

[38] H. Sun and C. Li, “Comparison of Unilateral and Bilateral Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures: A Systematic Review and Meta-Analysis,” Journal of Orthopaedic Surgery and Research 11, no. 1 (2016): 156.

RIGHTS & PERMISSIONS

2025 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.