Is P TO P (Pedicle-To-Pedicle) technique superior to bilateral percutaneous vertebral augmentation for thoracic and lumbar osteoporotic vertebral compression fracture? Evidence from a retrospective study

To evaluate the safety, accuracy, and efficacy of Percutaneous Vertebral Augmentation using the P TO P (Pedicle-To-Pedicle) technique in the treatment of thoracolumbar OVCF in order for it to optimize treatment. Patients treated with the P TO P technique (P TO P group) or traditional Bilateral Percutaneous Vertebral Augmentation (BPVA group) from January 2022 through December 2023 at our healthcare facility were retrospectively reviewed. Clinical indexes VAS and LAS, imaging indexes kyphosis angle, cement distribution, and complications such as cement leakage and adjacent vertebral fracture were compared and analyzed between the two groups. Eighty-nine patients with thoracolumbar OVCF were successfully treated (P TO P group enrolled 60 patients, BPVA group enrolled 29 patients). Operation time, bleeding and image assisted frequency were significantly lower in the P TO P group than in the BPVA group. All patients showed significant improvement in VAS, LAS and Cobb compared to the preoperative period, however, the improvement in VAS and LAS was more favorable in the immediate postoperative period in the P TO P group than in the BPVA group. With the exception of one case of unilateral cement distribution in the P TO P group the rest of the patients achieved the desired uniform bilateral filling of the cement. In addition 13 cases of cement leakage occurred in the P TO P group were not statistically different from the 6 cases of cement leakage that occurred in the BPVA group, fortunately these were asymptomatic with no catastrophic outcome occurring. By the time of the final follow-up 5 adjacent vertebral fractures occurred in the P TO P group one adjacent vertebral fracture occurred in the BPVA group and of course no statistical difference was recognized. The application of the P TO P technique in PVA is safe, effective, and feasible, and can perfectly achieve unilateral puncture with bilateral cement dispersion, with shorter operative time, less bleeding, lower frequency of radiation exposure, and more pleasing improvement in early postoperative pain and mobility function compared with BPVA.