Comparison of efficacy of percutaneous vertebroplasty via unilaterally extrapedicular versus transpedicular approach for osteoporotic thoracolumbar compression fractures

This investigation aimed to conduct an objective comparison of operative efficacy and cement-related complications between the unilateral extrapedicular approach and the conventional transpedicular approach in percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures (OVCFs). Although prior randomized and retrospective studies have compared these approaches, most have focused on lumbar fractures or used small samples. This study adds to the existing evidence by providing a mixed thoracolumbar cohort with detailed subgroup analysis and rigorous multivariable adjustment, with particular emphasis on whether the statistically significant difference in cement volume is clinically meaningful. A retrospective analysis was performed on clinical records of patients undergoing PVP for osteoporotic thoracolumbar compression fractures at our institution between January 2022 and January 2023. Fracture morphology (Genant grade, height loss, kyphotic angle, posterior wall status, fracture acuity) was systematically recorded. Patients were allocated to group A (transpedicular approach) or group B (unilateral extrapedicular approach). The choice of approach was based on temporal clustering and surgeon preference, not on fracture characteristics. Demographic characteristics, perioperative metrics, visual analogue scale (VAS) scores, and Oswestry disability index (ODI) scores were evaluated and compared across the two cohorts. The study enrolled 138 patients (mean follow‑up 16.0 months). No significant intergroup differences were observed in operative duration or cement leakage incidence ( p > 0.05). The volume of cement injected was significantly greater in group B (4.45 ± 0.24 mL) compared with group A (4.31 ± 0.30 mL) ( p = 0.002; absolute difference 0.14 mL). Both groups exhibited marked postoperative improvement in VAS and ODI scores ( p < 0.05), with no significant between‑group differences at any time point ( p > 0.05). Subgroup analysis by thoracic/lumbar level and by Genant grade showed consistent findings. Vertebral height restoration was comparable between groups. Both unilateral PVP approaches effectively relieved pain and restored vertebral height. The extrapedicular approach yielded a statistically significant but not clinically meaningful increase in cement volume (0.14 mL, representing only 3.2% of the mean injected volume) without higher leakage. The two approaches were clinically equivalent in pain relief, functional recovery, and safety. Approach selection should be guided by surgeon preference and patient anatomy, not by anticipated cement volume differences. Formal equivalence testing was not performed, and the temporal clustering of approach assignment introduces potential confounding that should be addressed in future prospective studies.