Preoperative Planning of Lateral Entry Point is Necessary in Percutaneous Lumbar 5th Vertebroplasty.

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Preoperative Planning of Lateral Entry Point is Necessary in Percutaneous Lumbar 5th Vertebroplasty.

World Neurosurg. 2017 May 13;:

Authors: Lin HH, Chang MC, Chou PH, Hung PI, Wang ST, Liu CL

Abstract
BACKGROUND: To compare treatment outcomes and complications between the computer-assisted preoperative planning of lateral entry approach and the traditional approach for L5 percutaneous vertebroplasty.
METHODS: This prospective randomized clinical study was performed from January 2008 to December 2014, wherein 68 patients who received L5 percutaneous vertebroplasty were randomly divided into either group A, for which the traditional trans-pedicle approach was used, or group B, for which the computer-assisted lateral entry point approach was used for L5 percutaneous vertebroplasty. The Visual Analog Scale and Oswestry Disability Index were evaluated pre-operatively, post-operatively, and on latest-follow-up.
RESULTS: Patient demographics were similar between groups. The mean follow-up duration was 65 months. The mean distance between the entry point and the midline was 3.05 ± 0.5 cm in group A and 7.04 ± 0.7 cm in group B. The mean inclination angle measured on the preoperative axial image was 17.1° ± 3.4° in group A and 41° ± 3.8° in group B. Clinical outcomes were comparable; however, there was significantly greater cement leakages in group A than in group B (p< 0.001).
CONCLUSIONS: Owing to the hemispherical morphology and convergent pedicle axis of the L5 vertebrae, a more lateral skin entry point and convergent angle of the puncture needle should be emphasized to reach the optimal point according to preoperative assessment. A computer-assisted preoperative planning of the lateral entry point approach demonstrated a higher rate of bilateral cement infiltration with fewer complications.

PMID: 28512047 [PubMed - as supplied by publisher]

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