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. 2024 Oct 30;25:868. doi: 10.1186/s12891-024-07980-3

A novel unilateral extrapedicular approach applied to percutaneous vertebral augmentation to treat thoracic and lumbar Osteoporotic Vertebral Compression Fracture: a retrospective study

Bo Yang 1, Shenghai Wang 1,✉
PMCID: PMC11523804  PMID: 39478520

Abstract

Objective

To design and apply a novel puncture method, named P TO P technique, and to evaluate its efficacy and safety.

Method

The data of patients treated with PVA in medical institution from January 2020 to December 2022 were reviewed and analyzed. The degree of pain relief and recovery from daily activities were evaluated using VAS and LAS scores, and radiological parameters were evaluated using local kyphosis angle and excellent cement distribution. Complications such as cement leakage and recurrent vertebral fractures were also recorded.

Results

157 patients with thoracolumbar OVCF were successfully treated with novel puncture techniques. All postoperative clinical and radiological parameters significantly decreased in all patients, except for an increase in local kyphosis angle at the last follow-up compared to postoperative. All other above indicators remained statistically significant at the last follow-up compared to postoperative improvement. Except for 2 patients with poor cement distribution, the remaining 155 patients successfully achieved satisfactory results in unilateral puncture and bilateral cement distribution, achieving an excellent rate of 98.73%. In addition, 18 cases (11.46%) of cement leakage occurred during the operation, fortunately none of them were uncomfortable. During the postoperative follow-up period, 4 cases (2.55%) of recurrent fractures occurred. No other serious complications such as neurologic or named vascular injuries occurred.

Conclusion

The application of P TO P technology in thoracolumbar OVCF patients is safe and effective. It can not only reduce pain and quickly recover daily activities, but also achieve the perfect effect of unilateral puncture and bilateral cement filling.

Keywords: Osteoporotic vertebral compression fracture, Percutaneous vertebral augmentation, Extrapedicular, Cement distribution

Introduction

Since the changes of the Third World Industrial Revolution, the health care system has been improved and the quality of life of the people has risen step by step, especially in China, where the sense of well-being of the people has been greatly enhanced [1]. However, in an increasing number of countries and regions, fertility rates are declining, leading to a steady rise in the proportion of elderly people and a significant increase in the prevalence of osteoporosis [2].

Microstructural changes in bone make it less strong and more brittle, and low energy injuries such as falls below the patient’s height can result in fragility fractures. This is particularly true of the thoracolumbar spine, which is rich in cancellous bone. OVCF (Osteoporosis Vertebral Compression Fractures, OVCF) have become increasingly severe worldwide, with over 200 million cases reported worldwide and the number of cases continuously increasing [3, 4]. Fortunately, the majority of OVCF patients have been safely and effectively treated with this minimally invasive technique since 1984, when Galibert P and Deramond H [5] used radiographic guidance to fill and strengthen the spine with cement.

Currently, the treatment of OVCF is based on PVA, which mainly includes PKP and PVP [6]. Traditionally, the PVA puncture route was performed with the help of bilateral pedicles of the vertebral body, but many scholars have now taken to invade only the unilateral pedicle to enter the vertebral body to complete the operation because of its shorter operative time, less radiation exposure, lower cost, and clinical outcome no less than the traditional bilateral pedicle approach [7, 8]. However, the unilateral pedicle puncture technique in existing studies has been associated with damage to the posterior attachments of the spine, such as an increased risk of pedicle fracture versus increased articular synovial joint encroachment [9]. In addition, in order to achieve the imaging effect of cement filling into the contralateral pedicle, operators increase the angle of adduction of the puncture needle, which greatly increases the probability of penetrating the pedicle and violating the spinal canal, dura mater, and nerve roots [10, 11].

Therefore, there is an urgent need for a safe and efficient puncture method with uniform cement distribution to promote minimally invasive spinal techniques. Hence, the authors proposed a unilateral extracorporeal puncture technique full of novelty and used it in the treatment of OVCF in our medical institution. The puncture needle can reach the contralateral pedicle via one side of the extracorporeal pedicle, which can realize the ideal filling of the cemented contralateral pedicle, and we named this innovative technique as P TO P and wrote this paper to report the promising results of this method.

Methods

Study target

The medical records of OVCF who received treatment at our medical institution from January 2020 to December 2022 have been reviewed, as we need to conduct a retrospective analysis and research on patients who underwent new technologies, namely P TO P technology during this period. And 181 Intact medical records were accessed. Among them, there were54 male patients, 127 female patients. The research objectives are called from the database one by one for future research. This retrospective study was executed through the following inclusion and exclusion criteria: (1) Fresh thoracolumbar Osteoporotic Vertebral Compression Fractures confirmed by our medical institution or external medical institutions. (2) The posterior wall of the vertebrae filled with cement is intact or basically intact. (3) Fractured vertebrae were inserted through the unilateral paraspinal canal using a puncture needle and injected with bone cement, using the P TO P technique. (4) Mentally alert without unconsciousness disorder type of disease, enthusiastically cooperated with the study to carry it out. (5) Regular anti-osteoporosis therapy was received during the perioperative period and after discharge from the hospital. Exclusion criteria: (1) Vertebral fractures due to primary tumors or metastases. (2) Dysfunction of the patient’s limbs due to encroachment of the fractured vertebrae into the spinal canal and nerves. (3) Unable to trace contact after discharge. (4) No more than 1 year of continuous follow up.

Technical procedures

Patients in the prone position were subjected to PVA by the same experienced spine surgeon. The operated vertebra and its bilateral pedicles were marked with the help of a G-arm machine. The puncture point was selected at 9 o’clock, three fingers’ breadth from the left pedicle. Similarly, the puncture point on the right side is in the 3 o’clock direction with three fingers wide at the right pedicle. Whether you choose the left or right puncture point is entirely up to personal preference. It should be noted that only one side of the puncture point needs to be selected to successfully complete this operation. After local anesthesia is applied to the puncture site, slowly insert the 11th puncture needle. The ideal path for puncture into the vertebral body is from the bottom of the Cambin triangle, adjacent to the connection between the lateral pedicle and the vertebral body. The puncture needle reaches the target area under the guidance of G-arm fluoroscopy (on the front film, the inner edge of the contralateral pedicle is touched by a puncture needle, while on the side film, the first one-third of the injured vertebral body is reached by the puncture needle). The core of the puncture needle is then removed and the puncture path is tamped with the aid of a bone drill so that the expandable balloon can be smoothly implanted in the vicinity of the contralateral pedicle. The balloon was pressurized to 180mmHg, and The height of the superior or inferior endplates of the vertebral body is restored, which is clearly visible under G-arm fluoroscopy. The propped-up balloon is placed in the injured vertebra for 1 min and can then be withdrawn, followed by a slow push of the prepared draw phase cement into the injured vertebra. The G-arm fluoroscopy is used to visualize every 1/4 tube of cement injected. In general the cement can diffuse from the perforating side of the pedicle to the contralateral pedicle, regardless of whether the thoracic or lumbar spine is selected. We therefore innovatively defined this puncture technique as P TO P. Ideally the procedure is not concluded until the fractured vertebrae are satisfactorily filled with cement. As soon as a tendency for the cement to leak into the posterior margin of the vertebral body is detected, the push should be stopped. Of course, if the loss of height of the fractured vertebral body is not significant, cement can be injected into the fractured vertebral body without the aid of the kyphoplasty ballooon. At the end of the cement injection, the puncture point is sterilized and bandaged, and the patient is assisted to turn over after the cement specimen on the sterile table has completed the polymerization reaction. After checking that the patient had good sensory and motor function in the lower limbs, the procedure was concluded. The above depicted procedure are shown in Fig. 1.

Fig. 1.

Fig. 1

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Surgical procedures. A 76-year-old female suffering from OVCF(L1) under-went PKP with P TO P a, b The puncture needle was used to invade the fractured vertebral body by way of the paraspinal pedicle at the base of Cambin’s triangle. c, d The puncture needle reaches the ideal position, that is, on the front film, the inner edge of the contralateral pedicle is touched by a puncture needle, while on the side film, the first one-third of the injured vertebral body is reached by the puncture needle. e, f Bone drills were used to tamp down the puncture target area for smooth injection of cement while probing around the target area with a probe. g, h Vertebrae with significant loss of height are reset with the aid of balloon. i, j Cement was smoothly pushed into the injured vertebrae, and adhesion of the contralateral pedicle to the cement was observed

Post-operative treatment plan

Routine postoperative cardiac monitoring was performed for 6 h with absolute bed rest for 12 h. Simultaneous use of bisphosphonates for anti-osteoporosis. The imaging data were reviewed on the second postoperative day, and if there was no abnormality, discharge could be arranged. Continue sequential anti-osteoporosis treatment after discharge, such as oral osteotriol, calcium carbonate D3 and teriparatide.

Observation parameters

Pain with its accompanying changes in mobility serves as the main reason for patients to come to the healthcare facility, so we used the most commonly used visual analogue scale (VAS) with the LAS score to document changes in patient discomfort during the perioperative period. A score of 0 indicates no pain and a score of 10 indicates extreme pain. A score from 0 to 10 indicates that the pain symptoms are becoming more and more intolerable. The same LAS scoring system as in previous studies was used to assess changes in patient activity and function [12]. The score ranges from 1 to 4 points, with 1 point representing daily life is not limited by the disease and is not significantly different from the normal population. 2 points indicates that the patient is limited in walking and can only partially accomplish the goal of walking while enduring pain. 3 points indicates inability to walk alone, requiring the assistance of a wheelchair, or being confined to a sitting position. 4 points indicates that the patient is afraid to walk and is severely limited in daily activities and confined to bed.

We also observed and recorded imaging indicators, local kyphosis angle (Cobb), and cement distribution. The former refers to the angle formed between the upper endplate of the adjacent vertebre and the lower endplate of the adjacent vertebre, while the latter defines the goodness of cement distribution based on whether it is filled into the contralateral pedicle. Infiltration of cement into the contralateral pedicle is considered an excellent distribution, while conversely, it is considered an unsatisfactory distribution. And it is demonstrated by Fig. 2.

Fig. 2.

Fig. 2

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Puncture route and cement distribution. Line A represents the cross-sectional route to the interior of the fractured vertebrae using the P TO P technique via the lateral side of the pedicle puncture. Line segment B is the horizontal line of the medial margin of the contralateral pedicle. If the cement diffuses smoothly to the contralateral B line, it represents perfect cement distribution, and failure to cross the B line represents suboptimal cement distribution

More importantly, intraoperative and postoperative complications were also well documented. A special point is the identification and documentation of cement leakage with the help of intraoperative G-arm fluoroscopy machine and postoperative CT. Patients were closely followed up after surgery, including outpatient review and telephone communication, continuous follow-up until at least 12 months postoperatively. During the follow-up period, Magnetic resonance imaging of the thoracic and lumbar spine will be performed during follow-up once the patient complains of lower back pain to determine if there is a recurrence of a vertebral fracture, either in an adjacent spine or a distant spine.

Statistical analysis

The data collected was statistically analyzed with the help of PSS18.0 software (IBM, USA). First determine whether the continuous data is normally distributed or not, if it conforms to a normal distribution and the variance is chi-square, it is denoted as (x ± s). Continuous data from different observation periods were compared using paired t-tests, and the chi-square test was used if differences in categorical data between time periods needed to be compared. The bilateral difference test level was 0.05, representing a statistically significant difference (p < 0.05).

Results

Patient characteristics

After careful correction of the information on the 181 patients proposed for inclusion in the study, 24 patients were excluded (20 patients could not be contacted for follow-up due to a change of residence or phone number, 3 patients presented to the medical facility with symptoms of nerve damage to both lower extremities, a patient underwent surgery due to a painful myeloma), so 157 patients who met the study criteria were finally included. Among them, 108 were female and 49 male. The mean age of the 157 patients in the P TO P group was 74.64 ± 8.79 years (57–95). The Body Mass Index and Bone Mineral Densit of patients who underwent surgery with P TO P technique were 22.61 ± 2.89 and − 3.22 ± 0.29, respectively.

The frequency of radiation using the G-arm recorded during the operation procedure, and the average frequency of radiation exposure was 10.34 ± 1.85 times in 157 patients. An average of 27.39 ± 2.92 min of operation time was used to perform 70 cement injections on the thoracic vertebrae, and cement was infused into 108 lumbar vertebrae. The average amount of cement injected into each vertebra is 5.14 ± 1.10 ml. It is not surprising that the average bleeding volume during surgery was 15.33 ± 5.39 ml. The basic medical record information during the perioperative period is shown in Table 1; Figs. 3 and 4.

Table 1.

Basic information on all recipients

P To P (n = 157)
Age 75.38 ± 8.83
BMI 22.61 ± 2.89
T -3.22 ± 0.29
Mumber 10.34 ± 1.85
Cement volume(ml) 5.14 ± 1.10
operation time(min) 27.39 ± 2.92
intraoperative blood loss(ml) 15.33 ± 5.39
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The baseline surgical information for all subjects is presented in the table above

Fig. 3.

Fig. 3

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Baseline data. Total number of subjects 157 of which 108 were females 49 were males, females were the main participants

Fig. 4.

Fig. 4

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Operation position. 178 vertebrae were injected with cement, including 70 thoracic vertebrae and 108 lumbar vertebrae, with the lumbar vertebrae being the main fracture site as well as the vertebrae that were admired for being injected with cement

Clinical outcomes

All 157 patients successfully completed PVA. The visual analogue scale (VAS) of the patients with P TO P before operation, immediately after operation and 12 months after operation were (7.13 ± 0.59), (3.01 ± 0.68), (1.09 ± 0.47), respectively. Immediately after surgery and 12 months after surgery, the visual analogue scale (VAS) of P TO P group was significantly lower than those before surgery. However, there was a statistical difference between the VAS scores at 12 months postoperatively and in the immediate postoperative period, the VAS scores increased at 12 months postoperatively compared to the immediate postoperative period. The patients’ LAS before operation, immediately after operation and 12 months after operation were (3.07 ± 0.47), (1.85 ± 0.45), (1.01 ± 0.11), respectively. The LAS activity scores of P TO P group immediately after operation and 12 months after operation were also significantly lower than those before operation, and there was a statistical difference between the LAS scores at 12 months postoperatively and in the immediate postoperative period, indicating a decrease in LAS scores compared to immediately after surgery. The local kyphosis angle (Cobb) of the patients with P TO P before operation, immediately after operation and 12 months after operation were (25.56 ± 3.66), (19.95 ± 2.62), (20.80 ± 2.88), respectively. Immediately after surgery and 12 months after surgery, the local kyphosis angle (Cobb) of P TO P group was significantly lower than those before surgery. Similarly, there was a statistical difference between the local kyphosis angle (Cobb) at 12 months postoperatively and in the immediate postoperative period, the local kyphosis angle (Cobb) climbed at 12 months postoperatively compared to the immediate postoperative period (Table 2).

Table 2.

Perioperative clinical observations

VAS LAS Cobb P value (compared with preoperative)
Pre-Operation (n = 157) 7.13 ± 0.59 3.07 ± 0.47 25.56 ± 3.66
Post-Operation (n = 157) 3.01 ± 0.68 1.85 ± 0.45 19.95 ± 2.62 < 0.001⋆
Last-Operation (n = 157) 1.09 ± 0.47 1.01 ± 0.11 20.80 ± 2.88 < 0.001⋆
P value (compared with postoperative) < 0.001⋆ < 0.001⋆ < 0.001⋆
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Immediately after operation and 1 year after operation, the visual analogue scale (VAS), activity function score (LAS) and localized kyphosis(Cobb) were significantly lower than those before operation. All of these were statistically different at the final follow-up compared to the postoperative period

Complications

All 157 patients were successfully completed using the P TO P technique, with 155 achieving cement diffusion along the unilateral puncture pathway to the contralateral pedicle, and although only 2 patients had suboptimal cement placement, the overall 98.73% excellence rate of the cement was commendable (Fig. 5). A total of 18 cases (11.46%) of cement leakage occurred during the surgery, fortunately none of them were uncomfortable (Fig. 6). Postoperative follow-up period, 4 cases (2.55%) of recurrent fractures occurred (Figs. 7 and 8).

Fig. 5.

Fig. 5

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Cement distribution. With the exception of 2 patients in whom the cement did not reach the contralateral pedicle, the contralateral pedicles of the remaining 155 patients were satisfactorily filled with bone cement

Fig. 6.

Fig. 6

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Cement leakage was detected with the help of intraoperative G-arm in 18 patients, fortunately none of them were uncomfortable

Fig. 7.

Fig. 7

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Vertebral refracture. Four patients were found to have sustained recurrent thoracolumbar fractures after follow-up, and the remaining 153 patients who could be freely contacted did not suffer further fragility fractures

Fig. 8.

Fig. 8

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Typical case. A 86-year-old female suffering from OVCF(L2) under-went PVP with P TO P a, b Preoperative imaging data suggests signs of second lumbar vertebral fracture. c, d Perfusion of cement into the injured vertebrae using the P TO P technique. e, f Postoperative DR showed that the cement filled the contralateral pedicle uniformly with perfect cement attachment. g CT also suggests homogeneous cement filling in the contralateral pedicle region

Discussion

The main structure of bones is the bone matrix, which contains inorganic substances mainly composed of hydroxyapatite crystals, organic substances mainly composed of collagen, and liquid components. Inorganic substances give bones hardness and compressive strength, while organic substances synthesized by osteoblasts give bones strength and rigidity. As age increases, the number of trabeculae in trabecular bone decreases, cortical bone thickness decreases, and overall bone mass metabolism shows a state of loss. Over time, it has evolved into osteoporosis, known as the silent killer [13].This is accompanied by Osteoporotic Vertebral Compression Fracture. Fortunately, cement infusion strengthening of fractured vertebrae has become increasingly sophisticated after more than 30 years of development, and a variety of puncture techniques have been developed in clinical practice [14–16].

The initial route of cement injection into the injured vertebrae was bilateral [17], but due to the long puncture time and frequent radiation exposure, it gradually evolved to unilateral cement injection via the pedicle [18]. It is difficult to inject the cement uniformly into the contralateral region via the unilateral pedicle, and there is a risk of canal encroachment due to excessive abduction of the puncture angle [19]. In addition, the puncture route through the pedicle is very destructive to the posterior bony structures of the spine, such as the articular synchondrosis and the pedicles, and patients often have residual pain for a period of time after the operation, which greatly reduces the benefit of minimally invasive surgery for the patients [20].

Therefore, designing a safe and efficient puncture pathway is imperative. A controlled puncture path is achieved by placing the puncture target at the site where the posterosuperior aspect of the pedicle meets the vertebral body. This location is at the bottom of the Kambin’s triangle of safety, with sparse distribution of nerves and blood vessels and low risk of puncture. At the same time, the puncture path does not encroach on the pedicle, and the angle of the puncture path is adjusted so that it does not puncture the medial wall of the pedicle and irritate the dura mater and nerve roots. In addition, the puncture path did not pass through the articular synovial joints and pedicles, reducing residual pain due to postoperative residual medical spinal accessory injuries. Since our body puncture point was three fingers outside the lateral aspect of the vertebral arch root body projection point, we had a large abduction angle, which allowed us to smoothly place the puncture needle in the vicinity of the contralateral vertebral arch root to achieve the clinical and imaging efficacy of homogeneous dispersion of cement within the injured vertebrae. Imaging clearly demonstrates that a puncture from the vicinity of the pedicle on one side reaches the target point near the pedicle on the opposite side, and the cement fills uniformly near the contralateral pedicle, i.e., from the pedicle to the pedicle, which is named P TO P, and the technique is carried out in this medical structure.

It is encouraging to note that patients treated with this novel technique have favorable clinical outcomes, including immediate pain relief and a gradual return to their usual social activities, and a reduction in the incidence of psychiatric disorders.

When the cement is injected into the injured spine, the heat generated by the polymerization reaction instantly destroys the sinus vertebral nerves attached to the spine, suddenly relieving the patient’s pain and improving his or her mobility [21]. In our study, the original pain of patients after PVA was significantly reduced, and the VAS scores immediately after and 12 months after surgery were significantly different from those before operation. This is generally consistent with previous studies in which VAS scores decreased from 7.3 preoperatively to 3.3 at 24 h postoperatively [22]. Prior to surgery, patients were completely bedridden due to pain and having to use a wheelchair to complete their daily activities, or even to move around. At the end of the operation, the patient’s function in daily activities improved significantly, and they could get out of bed and perform daily activities alone. Immediately after the operation and 1 year after surgery, the LAS scores were significantly lower than those before surgery, and there were statistically significant differences. This demonstrates that patients can achieve daily activities without significant impairment after surgery, avoiding complications such as venous thrombosis of the lower extremities, crashing pneumonia, and urinary tract infections caused by prolonged lying down [23]. The uniformly filled cement also corrected the localized kyphosis angle created by the loss of vertebral height, although the kyphosis angle gradually increased again at one year postoperatively, which may have been related to the progressive bone loss [24]. In addition, imaging data suggests that 18 patients experienced cement leakage, but all were asymptomatic in nature. Disasters such as pulmonary embolism and heart rupture caused by cement leakage have been avoided [25]. Due to the uniform filling of cement near the bilateral pedicle, stress transmission in the adjacent vertebral bodies was uniform, resulting in only 4 patients experiencing adjacent vertebral re fractures during the last follow-up, which is significantly lower than previous research reports [26].

This novel technique designed by us has yielded promising clinical results. Previous reports have explored unilateral puncture and infusion of cement. Qiao Y’s group achieved the effect of bilateral uniform filling inside the vertebral body through conventional unilateral transpedicular puncture with additional abduction angle. However, continuous follow-up of patients with sudden postoperative pain showed a higher incidence of adjacent vertebral fractures, which may be closely related to the uneven distribution of cement leading to changes in adjacent vertebral stress [27]. In order to achieve a uniform filling of the cement in the injured vertebra, scholars [28, 29] recognized that the adjustment of the adduction angle of the puncture path that pierces the pedicle is limited, because too large an adduction angle will pierce the medial pedicle and violate the nerves. Therefore, the puncture technique with a completely unilateral route to the pedicle was modified by moving the starting puncture point outward to the lateral aspect of the transverse process, and the puncture needle entered the vertebral body through the transverse process and pedicle, and this technique with a larger puncture angle and safe puncture space determined good clinical results [30]. Tao W et al. [31] reported that the cement was injected via unilateral transverse process-pedicle puncture in patients with OVCF at their medical institution, and the pain symptoms of all patients were significantly improved, and the amount of cement injected and the leakage rate were significantly better than that of the traditional bilateral pedicle approach. However, the puncture needle could not reach the contralateral pedicle and the cement spread to the contralateral pedicle by virtue of the fracture line and fluid pressure, and suboptimal filling of the cement occurred in some patients. In addition, unskilled surgeons need to repeatedly adjust the puncture needle and surgical fluoroscopy, which may increase the patient’s pain and radiation exposure [20].

Other novel ideas for puncture have also been reported. For example, a puncture into the vertebral body from the endplate outside and below the pedicle on one side was successfully completed in 96 patients, with the bone cement filling the injured vertebrae uniformly. There were no complications from the needle channel or the instrumentation. They demonstrated the technique in an in vitro autopsy and found that the angle of penetration avoided the dorsal nerve root ganglion, aorta, and singular vein, which are located posteriorly and superiorly to the point of penetration [32]. Wang LM et al. [33] also designed a novel unilateral puncture protocol for a 62-year-old female patient, performing a modified unilateral extra-vertebral approach, choosing the superior border of the extra-vertebral arch as the starting point for puncture, and puncturing the inferior border of the contralateral arch, and the procedure was completed in 20 min. Although the risk of pedicle rupture and spinal canal encroachment with these puncture methods is small, there is a possibility of injury to the great vessels. The lumbar artery is one of the most important anatomical landmarks adjacent to the spine. The lumbar artery travels posterolateral to the vertebral body, and it has been shown that an extra-vertebral approach carries a risk of injury to the lumbar artery.

Recently Liu BG et al. [34] reported a safe and efficient method of unilateral extraspinal puncture by placing the puncture point outside and above the pedicle, which is sparsely neuralized and vascularized in the area of Cambin’s safety triangle.48 patients with lumbar OVCF were successfully treated by this method, and all of them showed a significant decrease in postoperative VAS and ODI scores, which remained statistically significant at the last follow-up visit.89.6% of the patients showed good cement distribution imaging but still 5 patients had poor distribution. However, our good rate was 98.73 and only 2 patients had poor cement distribution.16.7% cement leakage rate was calculated, though all were asymptomatic, which is higher than the leakage rate of 11.46 in our study. No segmental lumbar artery or nerve root injuries were found. The disadvantage is for the fact that they used the method only in patients with lumbar spine fractures. Unlike in our study, all thoracolumbar patients underwent this novel puncture technique, and in addition we increased the angle of abduction during puncture to place the target at the contralateral pedicle, which resulted in a beautiful cement filling.

In conclusion, our puncture method has the following advantages. First, uniform cement filling of bilateral pedicles. Secondly, the posterior bony structures of the spine, such as the pedicles and synovial joints, are rarely damaged. Furthermore, the short operation time reflects the concept of accelerated rehabilitation, which enables the patient to return to family and social life as soon as possible.

The limitations of this study are the single-center, retrospective and short follow-up period. Long-term complications of this innovative technique remain unrecognized. In addition, a control group was not available to clearly highlight the clinical and imaging superiority of this innovative technique. In the future, we will continue to refine the study to make this technique more mature, safe and effective.

Conclusion

The application of P TO P technology in thoracolumbar OVCF patients is safe and effective. It can not only reduce pain and quickly recover daily activities, but also achieve the perfect effect of unilateral puncture and bilateral cement filling.

Acknowledgements

Not applicable.

Abbreviations

PVA

Percutaneous Vertebral Augmentation

PKP

Percutaneous Kyphoplasty

PVP

Percutaneous Vertebroplasty

OVCF

Osteoporotic Vertebral Compression Fracture

MRI

Magnetic Resonance Imaging

VAS

Visual Analog Scale

BMI

Body Mass Index

SPSS

Statistical Packages for Social Scinences

Author contributions

Bo Yang conceived the research design, Bo Yang collected data and papered the manuscript, Shenghai Wang revised this article, Shenghai Wang is responsible for this article.

Funding

This work did not receive any grant from any agency in the public, commercial, or not-for-profit sector.

Data availability

The data was used and analyzed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

The portions of this study involving human participants, human materials, or human data were conducted in accordance with the Declaration of Helsinki and were approved by the Hanzhong Central Hospital Ethics Review Board (2024-82). The patients participants provided their written informed consent to participate in this study.

Consent for publication

Not applicable.

Clinical trial number

Not applicable.

Competing interests

The authors declare no competing interests.

Footnotes

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data was used and analyzed during the current study are available from the corresponding author on reasonable request.

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