Preoperative planning of compact zone trajectory is necessary in treating osteoporotic vertebral compression fracture with endplate involvement: A prospective randomized controlled study

Abstract

AbstractBackground Treatment strategy focusing on osteoporotic vertebral body and endplate fracture is not emphasized. This prospective randomized controlled study aimed to compare the clinical and radiological outcomes between reduction methods with or without compact trabecular bone during percutaneous kyphoplasty in osteoporotic vertebral fractures. Methods 100 patients who underwent percutaneous kyphoplasty were randomly divided into groups A (the guide pin and balloon were introduced into fracture site directly) and B (the guide pin and balloon were inserted away from the fracture site). Surgical duration, clinical and radiological outcomes at postoperative and follow-up, and complication of cement leakage and adjacent fracture were recorded. Patients were followed up for an average of 20.18 months. Clinical outcome was assessed using the Oswestry disability index and visual analogue scale (VAS). Results Both groups had similar patient demographics. Two groups had similar operation time and injected cement volume. The method of elevating the collapsed endplate indirectly had no significant influence on radiological outcomes, however, there was significant influence on decreasing intradiscal cement leakage and postoperative functional outcomes at 1-month and 12-month follow-up. Conclusion Elevating and reinforcing the collapsed endplate rather than just fulfilling the defect during percutaneous kyphoplasty is a safe and more effective way in pain and functional improvement with lower rates of further collapse in the osteoporotic vertebral fractures with endplate destruction.