Quantitative Comparison of Vertebral Structural Changes After Percutaneous Vertebroplasty Between Unilateral Extrapedicular Approach and Bilateral Transpedicular Approach Using Voxel-Based Morphometry

Abstract

Objective: To compare unilateral extrapedicular vertebroplasty (UEV) and bilateral trans-pedicular vertebroplasty (BTV) by quantitatively calculating the structural changes of frac-tured vertebral body after percutaneous vertebroplasty (PVP) using 3-dimensional voxel-based morphometry (VBM). Methods: We calculated bone cement volume (BCV); vertebral body volume (VBV); leaked intradiscal BCV; and spatial, symmetric, and even bone cement distribution (BCD) in and out of 222 vertebral bodies treated with 2 different PVPs using VBM and evaluated the incidence of subsequent vertebral compression fracture (SVCF). Statistical analyses were con-ducted to compare values between the 2 different PVPs. Results: Relative BCV, which is a potential risk factor for SVCF, was higher in the BTV group based on the data using VBM (0. 22 ± 0. 03 vs. 0. 29 ± 0. 03; p < 0. 001, t-test); however, the SVCF incidence between the 2 surgeries was not significantly different (UEV, 24. 7%; BTV, 31%; p = 0. 046, chi-square test). Spatial, even, and symmetric BCD along the 3 axes was not significantly different between UEV and BTV using VBM (x, y, z-axis, p = 0. 893, p = 0. 590, p = 0. 908 respectively, chi-square test). Conclusion: Contrary to intuitive concerns, UEV can inject a sufficient and more optimal BCV than BTV. Additionally, it can inject bone cement spatially, symmetrically, and even-ly well-distributed without an increased rate of intradiscal leakage and SVCF compared with BTV based on VBM. Therefore, UEV could be a superior alternative surgical method with similar clinical effectiveness and safety, considering the above results and the consensus that UEV is less invasive.