Abstract
Introduction
Objective
The aim of the study is to investigate the anatomical feasibility of percutaneous kyphoplasty for lumbar osteoporotic vertebral compression fractures via a unilateral transverse process-pedicle approach (TPA).
Summary of Background
Kyphoplasty via a unilateral approach has been reported and good clinical results have been achieved. However, because of the lack of an anatomical study, these approaches have yet to be popularized.
Materials and Methods
A total of 150 lumbar vertebral bodies of 30 patients were simulated kyphoplasty on computed tomography (CT) films through conventional pedicle approach (CTA) and the TPA, respectively. Anatomical parameters including the distance between the entry point and the midline of the vertebral body, the puncture inclination angle of medial inclination, were measured and compared.
Results
The distance between the entry point and the midline from L1 to L5 lumbar levels varied from 20.6 ± 2.2 mm to 28.6 ± 2.9 mm in the CTA group and from 23.6 ± 2.2 mm to 33.6 ± 2.9 mm in the TPA group. The entry point in the TPA group was 3.0 ± 2.1 mm to 5.1 ± 2.7 mm more lateral than that in the CTA group. The medial inclination angles in the TPA group were greater than that in the CTA group and the safe range of the puncture angles was also wider.
Conclusion
The entry point through a transverse process-pedicle approach was localized at the midline of the transverse process, 3.0 to 5.1 mm outside the lateral margin of the pedicle projection. Compared with CTA, the angle of inclination in the TPA approach was much larger with a wider safe puncture range. The TPA approach allowed an easy puncture to meet or surpass the midline of the lumbar vertebral body.
None declared