Unipedicular vertebroplasty for osteoporotic compression fracture using an individualized needle insertion angle

Objectives: In the classic transpedicular vertebroplasty, second needle placement is routinely required at the same level. However, each patient requires a different needle insertion angle (NIA) at each site. Therefore, precise NIA is required for each fractured vertebral body. In this study, we performed a unipedicular approach through an individualized NIA that had been evaluated with axial magnetic resonance imaging before vertebroplasty. Methods: We performed percutaneous vertebroplasty (PVP) on 103 vertebrae in 63 consecutive patients (50 women, 13 men; mean age, 70.4 y; range, 56 to 87 y). Before PVP, we measured the NIA for each pedicle. If leakage occurred without midline cement crossover, the unipedicular approach was stopped and changed to a bipedicular approach. Results: PVPs were performed from T7 to L5. We considered a successful outcome of a unipedicular approach to be when the center of vertebral body was filled with cement. Successful unipedicular PVPs were performed in 93 (90.3%) of 103 cases. Fifty-six of 63 patients were included for the pain evaluation. There was a statistically significant difference (P < 0.0001) between pre-visual analog scale (VAS) (84) and post-VAS (postoperatively at 1 d-VAS: 32, postoperatively at 1 mo-VAS: 34, and postoperatively at 3 mo-VAS: 37). No statistically significant difference was found between pre-NIAs and post-NIAs. A positive correlation was found between pre-NIAs and post-NIAs. Discussion: Unipedicular PVP can be performed safely, provided the operator has a thorough knowledge of the bony landmarks and the anatomy of the pedicle. A unipedicular approach could be considered first using individualized NIA at each vertebral level.