Preoperative CT-Based Planning for Unilateral Pedicle Approach PVP Reduces Cement Leakage and Improves Radiological Outcomes in Osteoporotic Vertebral Compression Fractures: A Retrospective Cohort Study

Abstract

Background Osteoporotic vertebral compression fractures are commonly treated with percutaneous vertebroplasty (PVP), though the conventional unilateral approach faces challenges in cement distribution and safety. This study aimed to evaluate whether a preoperative CT-based unilateral pedicle approach (CT-UPA) improves the outcomes of PVP. Methods This was a retrospective cohort analysis of patients undergoing PVP for single-segment thoracolumbar fractures between January 2020 and June 2024. Patients were divided into a CT-UPA group and a conventional unilateral approach (Conv-UPA) group. Perioperative indicators were recorded. Imaging assessments and clinical evaluations were conducted preoperatively, at 3 days, and 1 year postoperatively, with a final follow‑up at 1 year. Bone cement leakage was assessed via postoperative CT. Results A total of 222 patients were analyzed (CT-UPA: n=105; Conv-UPA: n=117). The CT-UPA group had a shorter mean surgery duration (56.43 vs 58.85 minutes, P=0.004), a higher mean injected cement volume (5.26 vs 4.09 mL, P<0.001), and a higher single-puncture success rate (96.19% vs 83.76%, P=0.002). Postoperatively, the CT-UPA group demonstrated significantly better Cobb angle correction, greater anterior vertebral height restoration, and superior cement distribution patterns. Visual Analog Scale and Oswestry Disability Index scores were significantly lower in the CT-UPA group at 3 days and 1 year. The overall cement leakage rate was significantly lower in the CT-UPA group (17.14% vs 32.48%, P=0.009), primarily due to a reduction in interspace leakage (4.76% vs 19.66%, P<0.001). Conclusion Preoperative CT-based planning for unilateral PVP enhances surgical precision, leading to superior radiographic outcomes, improved pain relief and function, and reduced cement leakage compared to the conventional fluoroscopy-guided method.