Abstract: BACKGROUND: Percutaneous kyphoplasty through a unilateral puncture approach is considered more effective than a bilateral puncture approach for the treatment of osteoporotic vertebral compression fractures. However, due to the unique anatomical shape and location of the L5 vertebral body, the traditional unilateral puncture approach has limited applicability in treating L5 osteoporotic vertebral compression fractures. To address this issue, we propose the use of the “O” point puncture approach.
OBJECTIVE: To compare the effectiveness of percutaneous kyphoplasty via basal transversal process-posterior superior pedicle-lateral articular process intersection (“O” point) with conventional approach percutaneous kyphoplasty in treating the L5 osteoporotic vertebral compression fractures.
METHODS: A retrospective analysis was conducted on 54 patients with L5 osteoporotic vertebral compression fractures treated with traditional percutaneous kyphoplasty or percutaneous kyphoplasty via the “O” point approach between January 2020 and December 2022 at Affiliated Hospital of Southwest Medical University. According to the surgical method, the patients were divided into the “O” point approach group (group A, n=29) and the traditional approach group (group B, n=25). The position of the “O” point and iliac spine and puncture angle were measured by orthography before operation in group A. Cobb angle, anterior vertebral margin, middle height, and bone cement distribution were compared between the two groups prior to and 2 days after surgery, and during final follow-up. Pain relief and daily living ability were assessed using the visual analog scale and Oswestry disability index prior to and 2 days after surgery, and during final follow-up. Complications related to the surgery were recorded.
RESULTS AND CONCLUSION: (1) Operative time and intraoperative fluoroscopy times were significantly shorter in group A than in group B (P < 0.05). However, no significant differences were observed in intraoperative blood loss or bone cement injection amounts between the two groups. (2) Both groups demonstrated significantly lower visual analog scale scores and Oswestry disability index on day 2 after surgery and at the last follow-up in comparison to before surgery. However, group A experienced a more noticeable decrease than group B (P < 0.05). (3) On both sides, the “O” point was located on average 1.23 cm below the highest point of the iliac spine line. The mean transverse distance between the “O” point and the iliac spine was 2.89 cm. (4) During the final follow-up, the Cobb angle of both groups exhibited significant improvements compared to their respective preoperative values (P < 0.05). However, there was no significant difference between the two groups (P > 0.05). (5) After operation, the distribution of bone cement was good in group A, accounting for 97% (28/29), and good in group B, accounting for 88% (22/25). Group A was significantly better than group B (P < 0.05). (6) The efficacy of percutaneous kyphoplasty utilizing the “O” point puncture technique on osteoporotic vertebral compression fractures of the L5 vertebra was superior to that of the traditional percutaneous kyphoplasty approach. However, the bone cement distribution achieved with percutaneous kyphoplasty via “O” point puncture was more satisfactory, and the puncture approach was able to circumvent the influence of a high iliac spine on the L5 vertebra.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: osteoporotic vertebral compression fracture, percutaneous kyphoplasty, “O” point, L5 vertebral body, bone cement