Unilateral Dual-Plane Puncture percutaneous vertebroplasty Reduces Re-collapse in Osteoporotic Vertebral Compression Fractures by Advancing Cement Delivery

Unilateral Dual-Plane Puncture percutaneous vertebroplasty Reduces Re-collapse in Osteoporotic Vertebral Compression Fractures by Advancing Cement Delivery | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Unilateral Dual-Plane Puncture percutaneous vertebroplasty Reduces Re-collapse in Osteoporotic Vertebral Compression Fractures by Advancing Cement Delivery Huo-Liang Zheng, Chang-hai Liu, Lei-Sheng Jiang, Xin-Feng Zheng, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4470138/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose: To evaluate the efficacy of a novel unilateral dual-plane puncture technique in improving bone cement distribution and reducing vertebral re-collapse following percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures (OVCFs). Methods: A randomized trial enrolled 145 patients diagnosed with OVCFs, who were then allocated into either traditional or unilateral dual-plane puncture groups. Bone cement distribution, vertebral height and segmental kyphotic angle was measured through postoperative X ray, while clinical outcomes were evaluated using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI). Results: The unilateral dual-plane puncture technique notably augmented bone cement contact with both superior and inferior endplates compared to conventional methods, achieving rates of 64.86% versus 40.85% (p < 0.001). This contributed to a significant reduction in the incidence of vertebral re-collapse within the first-year post-operation: 18.92% in the unilateral dual-plane group as opposed to 42.25% in the traditional group (p < 0.001). Furthermore, the unilateral dual-plane group exhibited markedly superior long-term efficacy, evidenced by mean VAS and ODI scores of 1.26 and 28.58, respectively, in comparison to 2.03 and 32.45 in the traditional group. Conclusions: The unilateral dual-plane puncture technique advances bone cement distribution within the vertebra, thereby reducing the risk of vertebral re-collapse following PVP surgery and improving long-term clinical outcomes for patients with OVCFs. Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction With the aging population and increasing emphasis on quality of life, osteoporosis is gradually becoming a societal concern for the elderly [ 1 – 3 ] . Fragility fractures resulting from osteoporosis represent a severe consequence, as reduced bone mass, decreased bone strength, and increased bone fragility make even minor trauma in daily activities capable of causing brittle fractures [ 4 – 6 ] . Such fractures often manifest as complete fractures, with osteoporotic vertebral compression fractures (OVCFs) being one of the most prevalent types [ 7 , 8 ] . The incidence of osteoporotic vertebral compression fractures is expected to increase with the intensification of population aging [ 9 ] . Treatment for these fractures includes conservative and surgical approaches. Conservative treatments involve bed rest, orthopedic bracing, and similar measures [ 10 – 12 ] . Common surgical interventions include fracture reduction and internal fixation, as well as percutaneous vertebral augmentation procedures [ 13 , 14 ] . Percutaneous vertebral augmentation comprises percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP), both of which effectively address osteoporotic vertebral compression fractures through minimally invasive procedures, alleviating pain, restoring vertebral height, and enhancing spinal stability [ 15 – 17 ] . However, a phenomenon of postoperative vertebral height loss has been observed in both PVP and PKP, which can lead to a return to preoperative states, exacerbating pain and causing spinal deformities, sometimes necessitating revision surgery. Lin et al. referred to the anterior height loss of vertebrae after PVP as "re-fracture", while Heo et al. described the post-PVP vertebral height loss as "re-collapse" [ 18 , 19 ] . Some studies suggest a close association between the distribution, morphology, and injection volume of bone cement and post-PVP vertebral re-collapse. The morphology and distribution of bone cement are believed to be associated with postoperative vertebral re-collapse [ 20 ] . Li et al. suggest that the distance between the bone cement and the upper endplate of the injured vertebra can more accurately reflect the dispersion of the cement [ 21 ] . A large distance increases the risk of postoperative height loss, and vertebral re-collapse mainly occurs where cement is not filled. Therefore, we introduced a novel unilateral dual-plane PVP puncture technique aimed at achieving a more ideal distribution of bone cement within the vertebral body, thereby attempting to reduce the risk of vertebral re-collapse following PVP surgery. Methods Patients This study was a prospective analysis of patients underwent PVP surgery in April 2019 to Dec 2021. This study employed a random allocation method, where patients were assigned to either the traditional group or the unilateral dual-plane puncture group using random numbers. The randomization process was conducted by an independent researcher. All enrolled patients underwent clinical assessment. Inclusion criteria were as follows: (1) Thoracolumbar vertebral compression fractures below T8 without additional fractures; (2) Males aged ≥ 55 years and postmenopausal females; (3) Single-segment OVCF and preoperative radiological examinations confirming fresh OVCF showing high signal on T2-weighted fat-suppressed MRI images; (4) Lumbar spine bone mineral density measured by dual-energy X-ray absorptiometry (DXA), with T value < -2.5 standard deviation (SD). Exclusion criteria included: (1) Spinal infection, thoracolumbar neoplastic fractures, and severe trauma occurring before enrollment; (2) Chronic corticosteroid use. (3) Other bone metabolism disorders such as osteomalacia. (4) Vertebral body posterior wall injury. A total of 189 patients were included in this study, with 145 patients completing the full follow-up. This study was approved by the institutional review board of Xinhua Hospital, affiliated with Shanghai Jiao Tong University School of Medicine. All participants received both written and verbal information before providing written consent, and the study was conducted in accordance with the principles of the Helsinki Declaration. Procedures All PVP surgeries were performed by Sheng-Dan Jiang. The patient was positioned prone, and the location of the fracture was determined utilizing C-arm fluoroscopy. The surgical procedure was performed under local anesthesia (1% lidocaine). Guided by X-ray, the needle was inserted at either the 10 o'clock position on the left pedicle or the 2 o'clock position on the right pedicle. During the puncture, the needle was slightly tilted towards the upper endplate of the vertebra. When the needle reached the anterior one-third of the vertebral body, bone cement was injected under monitoring by the C-arm machine. Subsequently, the puncture needle was withdrawn to the posterior edge of the vertebra, and the angle of the needle was adjusted to tilt slightly towards the lower endplate of the vertebra. After reaching the anterior one-third of the vertebral body, an appropriate amount of bone cement was injected (Figs. 1 and 2). Analgesics were administered orally only on the day of surgery. Imaging CT and MRI scans were performed preoperatively to accurately determine the location of the fracture and the extent of vertebral collapse, providing support for the surgery. X-ray examinations were conducted preoperatively, at 1-day post-surgery, 1-month post-surgery, 3 months post-surgery, and 1-year post-surgery to measure vertebral height and local kyphotic angle (LKA). Local kyphotic angle was defined as the angle between the upper endplate line and the lower endplate of the fractured vertebra. The distribution of bone cement was categorized as Full Endplate Contact, Partial Endplate Contact, and No Endplate Contact. Full Endplate Contact indicates that the bone cement simultaneously contacts both the superior and inferior endplates of the injured vertebra. Partial Endplate Contact indicates that the bone cement contacts either the superior or inferior endplate of the injured vertebra. No Endplate Contact indicates that the bone cement does not contact either the superior or inferior endplate of the injured vertebra. Re-collapse is defined as X-ray imaging at the last follow-up visit showing a decrease in anterior vertebral body height of more than 1.0 millimeters and an increase in the kyphotic angle of more than 3 degrees compared to day 1 after surgery. Clinical assessment Back pain severity changes were assessed using the visual analog scale (VAS), while the Oswestry Disability Index (ODI) was employed to evaluate patients' capacity for daily activities. Statistical Analysis Data analysis was performed using IBM SPSS Statistics 26. Continuous variables were presented as mean ± standard deviation. Normality was assessed using the Shapiro-Wilk test. The Mann-Whitney U test was employed to compare nonparametric variables between two groups, while the t-test was utilized for parametric variables. Furthermore, distribution analyses were conducted using the chi-square test and Fisher's exact test. A significance level of p < 0.05 was considered statistically significant. Results General characteristics of the patients These patients received PVP treatment at Xinhua Hospital, affiliated with Shanghai Jiao Tong University School of Medicine, from November 2021 to December 2022. Among them, 145 patients had complete information, with a mean follow-up time of 14.8 months (range: 12–18 months). The traditional PVP puncture group (n = 71) comprised 55 females and 16 males, with a mean age of 71.32 years. The unilateral double-plane PVP puncture group (n = 74) comprised 60 females and 14 males, with a mean age of 73.43 years. There was no significant difference in bone mineral density between the two groups (p = 0.66). Preexisting medical conditions of patients included hypertension (52 patients), diabetes (13 patients), and coronary atherosclerotic heart disease (13 patients) (Table 1 ). There were no significant differences between the two groups in terms of preoperative anterior vertebral height (AVH), local kyphotic angle (LKA), lumbar lordosis angle (LL), and thoracolumbar kyphosis angle (TLK) (Table 2 ). Also, there were no differences in preoperative VAS and ODI scores between the two groups (Table 2 ). Table 1 Descriptive Statistics of the Subjects in the Study (x ± s, n = 145) Characteristics t-PVP (n = 71) ud-PVP (n = 74) p Age at surgery 71.32 ± 6.53 73.43 ± 6.81 0.07 U Gender Female 55 (77.46%) 60 (81.08%) 0.68 F Male 16 (22.54%) 14 (18.92%) BMI (kg/m 2 ) 24.49 ± 4.45 23.62 ± 3.98 0.22 T Hypertension 23 (32.39%) 29 (39.19%) 0.49 F Diabetes 7 (9.86%) 6 (8.11%) 0.78 F CHD 5 (7.04%) 8 (10.81%) 0.56 F BMD (T-score) -3.26 ± 0.45 -3.29 ± 0.45 0.66 U Fracture site T9 1(1.41%) 2 (2.7%) 0.40 C T10 6 (8.45%) 2 (2.7%) T11 9 (12.68%) 6 (8.11%) T12 14 (19.72%) 20 (27.03%) L1 23 (32.39%) 19 (25.68%) L2 11 (15.49%) 14 (18.92%) L3 5 (7.04%) 4 (5.41%) L4 1 (1.41%) 6 (8.11%) L5 1 (1.41%) 1 (1.35%) Follow-up time (months) 15.08 ± 1.96 14.57 ± 1.89 0.11 U The symbol ‘U’ indicates the data was analyzed by the unpaired Mann–Whitney U test; The symbol ‘T’ indicates the data was analyzed by the unpaired t test; The symbol ‘F’ indicates the data was analyzed by the Fisher’s exact test; The symbol ‘C’ indicates the data was analyzed by the Chi-square test. t-PVP: Traditional puncture percutaneous vertebroplasty; ud-PVP: unilateral dual-plane puncture percutaneous vertebroplasty; BMI: Body Mass Index; CHD: Coronary Artery Atherosclerotic Heart Disease Table 2 Comparisons of preoperative parameters between traditional puncture PVP and unilateral dual-plane puncture PVP (x ± s, n = 145) Parameter t-PVP (n = 71) ud-PVP (n = 74) p VAS 7.45 ± 1.24 7.35 ± 1.24 0.63 T ODI 70.69 ± 9.91 70.0 ± 11.1 0.63 U Local kyphotic angle (LKA) 14.74 ± 7.89 14.97 ± 7.93 0.78 U Anterior vertebral height (AVH) 15.87 ± 4.34 15.51 ± 4.20 0.69 U posterior vertebral height (PVH) 23.74 ± 6.42 23.12 ± 6.07 0.67 U AVH/PVH 1.50 ± 0.03 1.50 ± 0.07 0.09 U Lordosis angle (LL) 41.63 ± 12.58 43.45 ± 13.7 0.41 T Thoracolumbar kyphosis angle (TLK) 17.17 ± 8.49 16.10 ± 7.17 0.40 T The symbol ‘U’ indicates the data was analyzed by the unpaired Mann–Whitney U test; The symbol ‘T’ indicates the data was analyzed by the unpaired t test. t-PVP: Traditional puncture percutaneous vertebroplasty; ud-PVP: unilateral dual-plane puncture percutaneous vertebroplasty; VAS: Visual analog scale; ODI: The Oswestry Disability Index. Bone cement distribution pattern In the unilateral dual-plane puncture group, the needle was guided through the unilateral pedicle, supplemented by retrograde manipulation to adjust the puncture angle, with the aim of maximizing simultaneous contact between the bone cement and the superior and inferior endplates. Postoperative X-rays were employed to assess the sagittal distribution of the bone cement within the vertebral body. Consistent with our expectations, in the traditional puncture group, 29 cases (40.85%) exhibited contact between the bone cement and the superior and inferior endplates. Notably, this proportion significantly increased to 48 cases (64.86%) in the modified puncture group, surpassing that of the traditional group. Within the traditional cohort, contact between the bone cement and only one endplate was observed in 35 instances (49.30%), while failure to engage both endplates was noted in 7 cases (9.85%), proportions notably higher than those observed in the modified group, which recorded 24 cases (32.43%) and 2 cases (2.7%), respectively (Table 3 ). Notably, although the mean usage of bone cement in the unilateral dual-plane group was higher than that in the traditional group, there was no significant statistical difference between the two groups in terms of the amount of bone cement used and the rate of bone cement leakage (Table 3 ). Table 3 Comparisons of postoperative parameters between traditional puncture PVP and unilateral dual-plane puncture PVP (x ± s, n = 145) Parameter t-PVP (n = 71) ud-PVP (n = 74) p Bone cement Volume (mL) 5.83 ± 1.43 5.89 ± 1.47 0.78 T Bone cement distribution Full Endplate Contact 29 (40.85%) 48 (64.86%) 0.01 C Partial Endplate Contact 35 (49.30%) 24 (32.43%) No Endplate Contact 7 (9.85%) 2 (2.70%) Bone cement leakage 28 (39.44%) 37 (50%) 0.24 F LKA 11.25 ± 6.13 11.79 ± 6.46 0.71 U AVH 17.06 ± 3.59 17.18 ± 3.52 0.84 T LL 43.79 ± 12.45 45.35 ± 13.46 0.47 T TLK 14.52 ± 8.68 12.91 ± 7.55 0.49 U The symbol ‘U’ indicates the data was analyzed by the unpaired Mann–Whitney U test; The symbol ‘T’ indicates the data was analyzed by the unpaired t test; The symbol ‘F’ indicates the data was analyzed by the Fisher’s exact test; The symbol ‘C’ indicates the data was analyzed by the Chi-square test. t-PVP: Traditional puncture percutaneous vertebroplasty; ud-PVP: unilateral dual-plane puncture percutaneous vertebroplasty. Clinical outcomes Although there were no significant differences in LKA, AVH, LL, and TLK between the two groups at one year postoperatively (Fig. 3), the changes in AVH and LKA from postoperative to one year postoperatively were greater in the traditional group than in the unilateral dual-plane puncture group (Table 4 ). Furthermore, clinical efficacy was assessed using Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). There were no significant differences in preoperative VAS and ODI scores between the two groups. On the first postoperative day, patients in both the traditional and unilateral dual-plane puncture groups experienced significant improvement in pain, with no significant difference between the groups in terms of improvement magnitude. During the 3-month follow-up period, clinical efficacy was comparable between the two groups. However, at 1 year postoperatively, patients in the unilateral dual-plane puncture group exhibited a statistically significant difference in VAS scores, with a mean of 1.26 compared to 2.03 in the traditional group. In terms of ODI scores, patients in the unilateral dual-plane group achieved an average score of 28.58, which was superior to the traditional group's score of 32.45 (Table 5 ). Table 4 Radiological parameters at one-year postoperative follow-up. (x ± s, n = 145) Parameter t-PVP (n = 71) ud-PVP (n = 74) p LKA 13.56 ± 6.46 13.10 ± 6.82 0.85 U AVH 16.05 ± 3.77 16.62 ± 3.70 0.28 U LL 42.59 ± 12.50 44.76 ± 13.67 0.32 T TLK 16.16 ± 8.62 13.80 ± 7.43 0.26 U Changed AVH 1.01 ± 0.77 0.57 ± 0.5 <0.01 T Changed LKA 2.30 ± 1.73 1.32 ± 1.3 <0.01 T The symbol ‘U’ indicates the data was analyzed by the unpaired Mann–Whitney U test; The symbol ‘T’ indicates the data was analyzed by the unpaired t test; The symbol ‘F’ indicates the data was analyzed by the Fisher’s exact test; The symbol ‘C’ indicates the data was analyzed by the Chi-square test. t-PVP: Traditional puncture percutaneous vertebroplasty; ud-PVP: unilateral dual-plane puncture percutaneous vertebroplasty. Table 5 Comparisons of postoperative VAS and ODI scores between traditional puncture PVP and unilateral dual-plane puncture PVP (x ± s, n = 145) VAS ODI t-PVP (n = 71) ud-PVP (n = 74) P t-PVP (n = 71) ud-PVP (n = 74) P 1 day after surgery 3.03 ± 0.91 2.88 ± 0.94 0.28 U 47.31 ± 9.11 45.96 ± 9.99 0.30 U 1 month after surgery 2.51 ± 1.07 2.41 ± 1.16 0.51 U 39.62 ± 9.15 37.42 ± 10.55 0.09 U 3 months after surgery 1.90 ± 1.19 1.80 ± 1.26 0.58 U 33.03 ± 7.77 31.89 ± 9.16 0.42 T 1 year after surgery 2.03 ± 0.99 1.26 ± 0.81 <0.01 U 32.45 ± 7.25 28.58 ± 7.14 <0.01 U The symbol ‘U’ indicates the data was analyzed by the unpaired Mann–Whitney U test; The symbol ‘T’ indicates the data was analyzed by the unpaired t test. t-PVP: Traditional puncture percutaneous vertebroplasty; ud-PVP: unilateral dual-plane puncture percutaneous vertebroplasty. Re-collapse Subsequently, we delved into the occurrence of re-collapse following PVP surgery. Within the traditional group, there were 30 cases (42.25%) of re-collapse within 1-year post-injury, significantly higher than the 14 cases (18.92%) observed in the unilateral dual-plane group (Fig. 4). This suggests that the unilateral dual-plane puncture technique can significantly reduce the incidence of vertebral re-collapse following PVP surgery. Further stratification was conducted based on whether the bone cement made simultaneous contact with the superior and inferior endplates. Among those in contact with both endplates, the re-collapse rate within 1-year post-injury was merely 3.9%. Conversely, the re-collapse rate post-surgery for cases where the bone cement only contacted one endplate or did not engage with the endplates at all was 60.29% (Table 6 ). This underscores the superior supportive effect provided by simultaneous contact with the superior and inferior endplates. Subsequently, we analyzed the imaging data of patients who experienced collapse despite contact with the superior and inferior endplates and found that all three cases were in the unilateral dual-plane puncture group. Despite simultaneous contact with the superior and inferior endplates, the adjustment in the angle of the puncture needle led to the bone cement not forming a contiguous structure within the vertebral body but rather a "bone cement-trabecular bone-bone cement" structure resembling a sandwich biscuit. This sandwich structure may concentrate stress on the intervening trabecular bone, rendering it prone to collapse. To ascertain whether the unilateral dual-plane puncture group reduced the occurrence of re-collapse by influencing the distribution of bone cement, we performed binary logistic regression analysis. When the puncture method was considered as a single-factor variable, we found a significant association between the puncture method and re-collapse occurrence. However, upon introducing bone cement distribution into the model, the puncture method no longer served as a significant risk factor for re-collapse. This suggests that the unilateral dual-plane puncture may mitigate the risk of vertebral re-collapse by altering the distribution of bone cement. Table 6 Comparisons of the impact of surgical procedure and bone cement distribution on vertebral re-collapse. (x ± s, n = 145) Non-recollapse group Re-collapse group p Surgical procedure t-PVP 41(57.75%) 30(42.25%) <0.01 F ud-PVP 63(81.08%) 14(18.92%) Bone cement distribution Full Endplate Contact 74(96.1%) 3(3.9%) <0.01 F Partial or no Endplate Contact 27(39.71%) 41(60.29%) The symbol ‘F’ indicates the data was analyzed by the Fisher’s exact test; Discussion The incidence of osteoporosis has risen to the seventh position among common diseases worldwide [ 22 ] . In China, the current elderly population is approximately 130 million, with an annual growth rate of 3.2% for individuals aged 60 and above. The prevalence of osteoporosis in China is around 6.6%, affecting a total of 60–80 million individuals, primarily among those aged 60 and above and postmenopausal women [ 23 – 26 ] . Within the osteoporotic population, approximately 700,000 vertebral compression fractures occur annually, constituting a significant factor leading to disability and even death in the elderly [ 27 ] . After a vertebral compression fracture, the original strength and stiffness of the vertebra are compromised, especially in the collapsed trabeculae within the upper half of the vertebral body. The repair of a fractured vertebra is directly influenced by the amount of bone cement, and an appropriate dosage can directly enhance the stiffness and strength of the operated vertebra, stabilize the vertebra, correct spinal deformities, and prevent further collapse. Cadaveric studies suggest that to restore the compressive strength of a vertebra, at least 15% cement filling is required. In the thoracolumbar spine, this translates to an average injection volume of 4–6 ml of bone cement per vertebra [ 28 ] . Li et al. found that the average cement usage in patients with re-fractures (3.30 ± 0.84 ml) was significantly lower than in those without fractures (4.46 ± 1.10 ml) [ 29 ] . Insufficient cement injection may lead to inadequate vertebral filling, insufficient support, and an increased risk of re-collapse. Injecting more cement can allow for a wider dispersion within the trabecular bone clefts, reducing areas without cement support. Therefore, an appropriate high-dose cement can lower the risk of further height loss post-enhancement. Insufficient bone cement injection is a risk factor for post-PVP vertebral re-collapse, and an adequate amount of bone cement is beneficial for better vertebral height restoration and stability. However, excessive bone cement injection increases the risk of cement leakage, with the potential for disastrous consequences such as nerve compression and severe pulmonary embolism [ 30 ] . Therefore, while ensuring an appropriate amount of bone cement injection, the distribution pattern of bone cement within the vertebra has become a focal point of study for some researchers. Studies suggest that the distribution of bone cement between the upper and lower endplates of the vertebra is more effective [ 31 ] . When the bone cement fully contacts both the upper and lower endplates, it enhances the restoration of vertebral body strength and preserves vertebral body height more effectively, thereby reducing the risk of vertebral body recompression and long-term pain. Based on this, some physicians adopt the surgical approach of bilateral dual-plane puncture PVP, intending to achieve contact between bone cement and the upper and lower endplates. However, bilateral dual-plane puncture PVP increases surgical time, fluoroscopy frequency, and trauma levels [ 32 ] . We propose, for the first time, a unilateral dual-plane puncture PVP through the transpedicular route. During puncture, the puncture needle is slightly inclined towards the plane of the upper endplate, reaching the midline of the vertebra through the lateral transpedicular route. Under C-arm guidance, bone cement is injected, and then the puncture needle is withdrawn to the posterior edge of the vertebra. The needle angle is adjusted to incline towards the plane of the lower endplate, and after reaching the midline of the vertebra, an appropriate amount of bone cement is injected. In preliminary studies, we found that unilateral dual-plane puncture PVP significantly increases the contact rate between bone cement and the upper and lower endplates, improving the distribution pattern of bone cement within the vertebra. As anticipated, the unilateral dual-plane puncture technique significantly increased the proportion of simultaneous contact between bone cement and the superior and inferior endplates compared to traditional puncture techniques. Simultaneously, it markedly reduced the probability of vertebral re-collapse postoperatively, thereby improving long-term clinical outcomes for patients. However, this does not imply that the unilateral dual-plane puncture technique is devoid of additional risks. We observed that excessive adjustment of the puncture angle in the unilateral dual-plane technique could lead to the formation of a sandwich-like structure comprising bone cement-trabecular bone-bone cement, increasing the likelihood of collapse in the intervening trabecular bone region. Limitations Our study has several limitations. Firstly, we determined the sagittal distribution of bone cement through postoperative spinal X-ray imaging. However, accurate measurements were sometimes challenging due to the obstruction caused by the bone cement. Secondly, the criteria we defined for re-collapse, involving a height decrease exceeding 1 mm and an angle increase greater than 3°, are relatively stringent, potentially leading to false positives. Lastly, solely assessing contact between bone cement and the superior and inferior endplates as a criterion for evaluating sagittal distribution may lack precision. A more comprehensive analysis could be achieved by quantifying the contact area between the bone cement and the endplates; however, this would require follow-up CT data, thereby increasing radiation exposure to patients during follow-up. Conclusion The unilateral dual-plane puncture technique can improve the distribution of bone cement within the vertebral body, reducing the incidence of vertebral re-collapse following PVP surgery and enhancing long-term clinical outcomes for patients postoperatively. Declarations Acknowledgements: We acknowledge all the participants in this study. Authors Contributions: Huo-Liang Zheng and Chang-hai Liu wrote the article. Lei-Sheng Jiang, Chang-hai Liu and Huo-Liang Zheng were responsible for data collection and analysis. Sheng-Dan Jiang was responsible for reviewing the data. Xin-Feng Zheng and Sheng-Dan Jiang were responsible for reviewing and revising the article. Funding: This study was supported by the Shanghai Sailing Program (23YF1425900), National Natural Science Foundation of China (82272535), National Natural Science Foundation of China (82302741) and Shanghai Municipal Hospital Development Center (SHDC2022CRD027). Availability of data and material: Data is available from the corresponding author. Conflict of Interest: The authors declare that they have no conflict of interest. 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Risk factors for pulmonary cement embolism associated with percutaneous vertebral augmentation: A systematic review and meta-analysis. Int J Surg (London England). 2022;101:106632. Chevalier Y, Pahr D, Charlebois M, Heini P, Schneider E, Zysset P. Cement distribution, volume, and compliance in vertebroplasty: some answers from an anatomy-based nonlinear finite element study. Spine. 2008;33(16):1722–30. Yang S, Chen C, Wang H, Wu Z, Liu L. A systematic review of unilateral versus bilateral percutaneous vertebroplasty/percutaneous kyphoplasty for osteoporotic vertebral compression fractures. Acta Orthop Traumatol Turc. 2017;51(4):290–7. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4470138","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":308714518,"identity":"bcf3d0ed-b3e2-4b53-8b71-34a6e8cbd0dd","order_by":0,"name":"Huo-Liang Zheng","email":"","orcid":"","institution":"Shanghai Jiaotong University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Huo-Liang","middleName":"","lastName":"Zheng","suffix":""},{"id":308714519,"identity":"66f641d0-7da5-447c-bbb4-ebe7e0289997","order_by":1,"name":"Chang-hai Liu","email":"","orcid":"","institution":"Chongming Hospital Affiliated to Shanghai University of Medicine and Health Sciences","correspondingAuthor":false,"prefix":"","firstName":"Chang-hai","middleName":"","lastName":"Liu","suffix":""},{"id":308714520,"identity":"bccc4345-da7a-4b18-9495-b059ecc00718","order_by":2,"name":"Lei-Sheng Jiang","email":"","orcid":"","institution":"Shanghai Jiaotong University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Lei-Sheng","middleName":"","lastName":"Jiang","suffix":""},{"id":308714521,"identity":"169cc713-7b62-46f7-8c4c-d5c176f3aff7","order_by":3,"name":"Xin-Feng Zheng","email":"","orcid":"","institution":"Shanghai Jiaotong University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Xin-Feng","middleName":"","lastName":"Zheng","suffix":""},{"id":308714522,"identity":"c26581a9-747d-4d91-9850-577c55cc2f89","order_by":4,"name":"Sheng-Dan Jiang","email":"data:image/png;base64,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","orcid":"","institution":"Shanghai Jiaotong University School of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Sheng-Dan","middleName":"","lastName":"Jiang","suffix":""}],"badges":[],"createdAt":"2024-05-24 05:31:45","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4470138/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4470138/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":58170633,"identity":"326a8e69-a1d0-4b8d-b81e-d67f9ce955d9","added_by":"auto","created_at":"2024-06-12 03:38:52","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":247823,"visible":true,"origin":"","legend":"\u003cp\u003eUnilateral dual-plane puncture technique under C-arm imaging. (A) The puncture needle is directed close to the upper endplate, reaching the anterior middle third of the vertebral body. (B) Injection of an appropriate amount of bone cement. (C) Withdrawal of the puncture needle. (D) Adjustment of the puncture direction towards the lower endplate. (E) The puncture needle reaches the mid-lower part of the vertebral body. (F) Injection of an appropriate amount of bone cement. (G-H) While retracting the puncture needle, inject bone cement simultaneously. (I) Postoperative spine anteroposterior X-ray acquired by C-arm machine.\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4470138/v1/35c45c8aa341d98bbed284d3.jpg"},{"id":58170636,"identity":"d9243c3f-b828-4f3d-ba91-a16b9c3ed439","added_by":"auto","created_at":"2024-06-12 03:38:52","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1661837,"visible":true,"origin":"","legend":"\u003cp\u003eUnilateral dual-plane vertebral augmentation surgery schematic.\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4470138/v1/825303460847a25180b738be.jpg"},{"id":58170635,"identity":"6b3fab05-33a7-4e8c-9c2a-62dc4a7a3cdb","added_by":"auto","created_at":"2024-06-12 03:38:52","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":909209,"visible":true,"origin":"","legend":"\u003cp\u003eAnterior vertebral body height and local kyphotic angle of the augmented vertebra during pre- and postoperative follow-up.\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4470138/v1/15b3fa76b41424b33a603752.jpg"},{"id":58170634,"identity":"62966009-2316-4405-9d4d-04e3a4d36335","added_by":"auto","created_at":"2024-06-12 03:38:52","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":144152,"visible":true,"origin":"","legend":"\u003cp\u003eThe comparison of postoperative vertebral collapse rates between the traditional group and the unilateral dual-plane puncture group.\u003c/p\u003e","description":"","filename":"Figure4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4470138/v1/0ff97097e182064fdd651a5b.jpg"},{"id":59446125,"identity":"ad5b4564-38e7-44c4-b72e-b348acbed3f4","added_by":"auto","created_at":"2024-07-01 23:44:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":4670561,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4470138/v1/a4c6fdba-ef9a-47cb-a0eb-573ad0c94fc6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Unilateral Dual-Plane Puncture percutaneous vertebroplasty Reduces Re-collapse in Osteoporotic Vertebral Compression Fractures by Advancing Cement Delivery","fulltext":[{"header":"Introduction","content":"\u003cp\u003eWith the aging population and increasing emphasis on quality of life, osteoporosis is gradually becoming a societal concern for the elderly\u003csup\u003e[\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. Fragility fractures resulting from osteoporosis represent a severe consequence, as reduced bone mass, decreased bone strength, and increased bone fragility make even minor trauma in daily activities capable of causing brittle fractures\u003csup\u003e[\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Such fractures often manifest as complete fractures, with osteoporotic vertebral compression fractures (OVCFs) being one of the most prevalent types\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe incidence of osteoporotic vertebral compression fractures is expected to increase with the intensification of population aging\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. Treatment for these fractures includes conservative and surgical approaches. Conservative treatments involve bed rest, orthopedic bracing, and similar measures\u003csup\u003e[\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. Common surgical interventions include fracture reduction and internal fixation, as well as percutaneous vertebral augmentation procedures\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. Percutaneous vertebral augmentation comprises percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP), both of which effectively address osteoporotic vertebral compression fractures through minimally invasive procedures, alleviating pain, restoring vertebral height, and enhancing spinal stability\u003csup\u003e[\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eHowever, a phenomenon of postoperative vertebral height loss has been observed in both PVP and PKP, which can lead to a return to preoperative states, exacerbating pain and causing spinal deformities, sometimes necessitating revision surgery. Lin et al. referred to the anterior height loss of vertebrae after PVP as \"re-fracture\", while Heo et al. described the post-PVP vertebral height loss as \"re-collapse\"\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. Some studies suggest a close association between the distribution, morphology, and injection volume of bone cement and post-PVP vertebral re-collapse. The morphology and distribution of bone cement are believed to be associated with postoperative vertebral re-collapse\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. Li et al. suggest that the distance between the bone cement and the upper endplate of the injured vertebra can more accurately reflect the dispersion of the cement\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. A large distance increases the risk of postoperative height loss, and vertebral re-collapse mainly occurs where cement is not filled.\u003c/p\u003e \u003cp\u003eTherefore, we introduced a novel unilateral dual-plane PVP puncture technique aimed at achieving a more ideal distribution of bone cement within the vertebral body, thereby attempting to reduce the risk of vertebral re-collapse following PVP surgery.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatients\u003c/h2\u003e \u003cp\u003eThis study was a prospective analysis of patients underwent PVP surgery in April 2019 to Dec 2021. This study employed a random allocation method, where patients were assigned to either the traditional group or the unilateral dual-plane puncture group using random numbers. The randomization process was conducted by an independent researcher. All enrolled patients underwent clinical assessment. Inclusion criteria were as follows: (1) Thoracolumbar vertebral compression fractures below T8 without additional fractures; (2) Males aged\u0026thinsp;\u0026ge;\u0026thinsp;55 years and postmenopausal females; (3) Single-segment OVCF and preoperative radiological examinations confirming fresh OVCF showing high signal on T2-weighted fat-suppressed MRI images; (4) Lumbar spine bone mineral density measured by dual-energy X-ray absorptiometry (DXA), with T value \u0026lt; -2.5 standard deviation (SD). Exclusion criteria included: (1) Spinal infection, thoracolumbar neoplastic fractures, and severe trauma occurring before enrollment; (2) Chronic corticosteroid use. (3) Other bone metabolism disorders such as osteomalacia. (4) Vertebral body posterior wall injury. A total of 189 patients were included in this study, with 145 patients completing the full follow-up. This study was approved by the institutional review board of Xinhua Hospital, affiliated with Shanghai Jiao Tong University School of Medicine. All participants received both written and verbal information before providing written consent, and the study was conducted in accordance with the principles of the Helsinki Declaration.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eProcedures\u003c/h2\u003e \u003cp\u003eAll PVP surgeries were performed by Sheng-Dan Jiang. The patient was positioned prone, and the location of the fracture was determined utilizing C-arm fluoroscopy. The surgical procedure was performed under local anesthesia (1% lidocaine). Guided by X-ray, the needle was inserted at either the 10 o'clock position on the left pedicle or the 2 o'clock position on the right pedicle. During the puncture, the needle was slightly tilted towards the upper endplate of the vertebra. When the needle reached the anterior one-third of the vertebral body, bone cement was injected under monitoring by the C-arm machine. Subsequently, the puncture needle was withdrawn to the posterior edge of the vertebra, and the angle of the needle was adjusted to tilt slightly towards the lower endplate of the vertebra. After reaching the anterior one-third of the vertebral body, an appropriate amount of bone cement was injected (Figs.\u0026nbsp;1 and 2). Analgesics were administered orally only on the day of surgery.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eImaging\u003c/h2\u003e \u003cp\u003eCT and MRI scans were performed preoperatively to accurately determine the location of the fracture and the extent of vertebral collapse, providing support for the surgery. X-ray examinations were conducted preoperatively, at 1-day post-surgery, 1-month post-surgery, 3 months post-surgery, and 1-year post-surgery to measure vertebral height and local kyphotic angle (LKA). Local kyphotic angle was defined as the angle between the upper endplate line and the lower endplate of the fractured vertebra. The distribution of bone cement was categorized as Full Endplate Contact, Partial Endplate Contact, and No Endplate Contact. Full Endplate Contact indicates that the bone cement simultaneously contacts both the superior and inferior endplates of the injured vertebra. Partial Endplate Contact indicates that the bone cement contacts either the superior or inferior endplate of the injured vertebra. No Endplate Contact indicates that the bone cement does not contact either the superior or inferior endplate of the injured vertebra. Re-collapse is defined as X-ray imaging at the last follow-up visit showing a decrease in anterior vertebral body height of more than 1.0 millimeters and an increase in the kyphotic angle of more than 3 degrees compared to day 1 after surgery.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eClinical assessment\u003c/h2\u003e \u003cp\u003eBack pain severity changes were assessed using the visual analog scale (VAS), while the Oswestry Disability Index (ODI) was employed to evaluate patients' capacity for daily activities.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eData analysis was performed using IBM SPSS Statistics 26. Continuous variables were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation. Normality was assessed using the Shapiro-Wilk test. The Mann-Whitney U test was employed to compare nonparametric variables between two groups, while the t-test was utilized for parametric variables. Furthermore, distribution analyses were conducted using the chi-square test and Fisher's exact test. A significance level of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eGeneral characteristics of the patients\u003c/h2\u003e \u003cp\u003eThese patients received PVP treatment at Xinhua Hospital, affiliated with Shanghai Jiao Tong University School of Medicine, from November 2021 to December 2022. Among them, 145 patients had complete information, with a mean follow-up time of 14.8 months (range: 12\u0026ndash;18 months). The traditional PVP puncture group (n\u0026thinsp;=\u0026thinsp;71) comprised 55 females and 16 males, with a mean age of 71.32 years. The unilateral double-plane PVP puncture group (n\u0026thinsp;=\u0026thinsp;74) comprised 60 females and 14 males, with a mean age of 73.43 years. There was no significant difference in bone mineral density between the two groups (p\u0026thinsp;=\u0026thinsp;0.66). Preexisting medical conditions of patients included hypertension (52 patients), diabetes (13 patients), and coronary atherosclerotic heart disease (13 patients) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). There were no significant differences between the two groups in terms of preoperative anterior vertebral height (AVH), local kyphotic angle (LKA), lumbar lordosis angle (LL), and thoracolumbar kyphosis angle (TLK) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Also, there were no differences in preoperative VAS and ODI scores between the two groups (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescriptive Statistics of the Subjects in the Study (x\u0026thinsp;\u0026plusmn;\u0026thinsp;s, n\u0026thinsp;=\u0026thinsp;145)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003et-PVP (n\u0026thinsp;=\u0026thinsp;71)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eud-PVP (n\u0026thinsp;=\u0026thinsp;74)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge at surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71.32\u0026thinsp;\u0026plusmn;\u0026thinsp;6.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73.43\u0026thinsp;\u0026plusmn;\u0026thinsp;6.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.07\u003csup\u003eU\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55 (77.46%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60 (81.08%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.68\u003csup\u003eF\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (22.54%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (18.92%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.49\u0026thinsp;\u0026plusmn;\u0026thinsp;4.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.62\u0026thinsp;\u0026plusmn;\u0026thinsp;3.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.22\u003csup\u003eT\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (32.39%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (39.19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.49\u003csup\u003eF\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (9.86%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (8.11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.78\u003csup\u003eF\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCHD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (7.04%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (10.81%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.56\u003csup\u003eF\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMD (T-score)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-3.26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-3.29\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.66 \u003csup\u003eU\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFracture site\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(1.41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (2.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"8\" rowspan=\"9\"\u003e \u003cp\u003e0.40\u003csup\u003eC\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (8.45%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (2.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (12.68%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (8.11%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (19.72%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (27.03%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (32.39%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (25.68%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (15.49%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (18.92%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (7.04%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (5.41%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1.41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (8.11%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1.41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.35%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFollow-up time (months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.08\u0026thinsp;\u0026plusmn;\u0026thinsp;1.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.57\u0026thinsp;\u0026plusmn;\u0026thinsp;1.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.11\u003csup\u003eU\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eThe symbol \u0026lsquo;U\u0026rsquo; indicates the data was analyzed by the unpaired Mann\u0026ndash;Whitney U test; The symbol \u0026lsquo;T\u0026rsquo; indicates the data was analyzed by the unpaired t test; The symbol \u0026lsquo;F\u0026rsquo; indicates the data was analyzed by the Fisher\u0026rsquo;s exact test; The symbol \u0026lsquo;C\u0026rsquo; indicates the data was analyzed by the Chi-square test.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003et-PVP: Traditional puncture percutaneous vertebroplasty; ud-PVP: unilateral dual-plane puncture percutaneous vertebroplasty; BMI: Body Mass Index; CHD: Coronary Artery Atherosclerotic Heart Disease\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparisons of preoperative parameters between traditional puncture PVP and unilateral dual-plane puncture PVP (x\u0026thinsp;\u0026plusmn;\u0026thinsp;s, n\u0026thinsp;=\u0026thinsp;145)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003et-PVP (n\u0026thinsp;=\u0026thinsp;71)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eud-PVP (n\u0026thinsp;=\u0026thinsp;74)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVAS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e7.45\u0026thinsp;\u0026plusmn;\u0026thinsp;1.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e7.35\u0026thinsp;\u0026plusmn;\u0026thinsp;1.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.63\u003csup\u003eT\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eODI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e70.69\u0026thinsp;\u0026plusmn;\u0026thinsp;9.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e70.0\u0026thinsp;\u0026plusmn;\u0026thinsp;11.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.63\u003csup\u003eU\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLocal kyphotic angle (LKA)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e14.74\u0026thinsp;\u0026plusmn;\u0026thinsp;7.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e14.97\u0026thinsp;\u0026plusmn;\u0026thinsp;7.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.78\u003csup\u003eU\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnterior vertebral height (AVH)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e15.87\u0026thinsp;\u0026plusmn;\u0026thinsp;4.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e15.51\u0026thinsp;\u0026plusmn;\u0026thinsp;4.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.69\u003csup\u003eU\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eposterior vertebral height (PVH)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e23.74\u0026thinsp;\u0026plusmn;\u0026thinsp;6.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e23.12\u0026thinsp;\u0026plusmn;\u0026thinsp;6.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.67 \u003csup\u003eU\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAVH/PVH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.09 \u003csup\u003eU\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLordosis angle (LL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e41.63\u0026thinsp;\u0026plusmn;\u0026thinsp;12.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e43.45\u0026thinsp;\u0026plusmn;\u0026thinsp;13.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.41\u003csup\u003eT\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThoracolumbar kyphosis angle (TLK)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e17.17\u0026thinsp;\u0026plusmn;\u0026thinsp;8.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e16.10\u0026thinsp;\u0026plusmn;\u0026thinsp;7.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.40\u003csup\u003eT\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eThe symbol \u0026lsquo;U\u0026rsquo; indicates the data was analyzed by the unpaired Mann\u0026ndash;Whitney U test; The symbol \u0026lsquo;T\u0026rsquo; indicates the data was analyzed by the unpaired t test.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003et-PVP: Traditional puncture percutaneous vertebroplasty; ud-PVP: unilateral dual-plane puncture percutaneous vertebroplasty; VAS: Visual analog scale; ODI: The Oswestry Disability Index.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eBone cement distribution pattern\u003c/h2\u003e \u003cp\u003eIn the unilateral dual-plane puncture group, the needle was guided through the unilateral pedicle, supplemented by retrograde manipulation to adjust the puncture angle, with the aim of maximizing simultaneous contact between the bone cement and the superior and inferior endplates. Postoperative X-rays were employed to assess the sagittal distribution of the bone cement within the vertebral body. Consistent with our expectations, in the traditional puncture group, 29 cases (40.85%) exhibited contact between the bone cement and the superior and inferior endplates. Notably, this proportion significantly increased to 48 cases (64.86%) in the modified puncture group, surpassing that of the traditional group. Within the traditional cohort, contact between the bone cement and only one endplate was observed in 35 instances (49.30%), while failure to engage both endplates was noted in 7 cases (9.85%), proportions notably higher than those observed in the modified group, which recorded 24 cases (32.43%) and 2 cases (2.7%), respectively (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Notably, although the mean usage of bone cement in the unilateral dual-plane group was higher than that in the traditional group, there was no significant statistical difference between the two groups in terms of the amount of bone cement used and the rate of bone cement leakage (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparisons of postoperative parameters between traditional puncture PVP and unilateral dual-plane puncture PVP (x\u0026thinsp;\u0026plusmn;\u0026thinsp;s, n\u0026thinsp;=\u0026thinsp;145)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003et-PVP (n\u0026thinsp;=\u0026thinsp;71)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eud-PVP (n\u0026thinsp;=\u0026thinsp;74)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBone cement Volume (mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.83\u0026thinsp;\u0026plusmn;\u0026thinsp;1.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.89\u0026thinsp;\u0026plusmn;\u0026thinsp;1.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.78 \u003csup\u003eT\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBone cement distribution\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFull Endplate Contact\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (40.85%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48 (64.86%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.01\u003csup\u003eC\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePartial Endplate Contact\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35 (49.30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (32.43%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo Endplate Contact\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (9.85%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (2.70%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBone cement leakage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (39.44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37 (50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.24\u003csup\u003eF\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLKA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.25\u0026thinsp;\u0026plusmn;\u0026thinsp;6.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.79\u0026thinsp;\u0026plusmn;\u0026thinsp;6.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.71\u003csup\u003eU\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAVH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17.06\u0026thinsp;\u0026plusmn;\u0026thinsp;3.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.18\u0026thinsp;\u0026plusmn;\u0026thinsp;3.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.84\u003csup\u003eT\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43.79\u0026thinsp;\u0026plusmn;\u0026thinsp;12.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45.35\u0026thinsp;\u0026plusmn;\u0026thinsp;13.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.47\u003csup\u003eT\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTLK\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.52\u0026thinsp;\u0026plusmn;\u0026thinsp;8.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.91\u0026thinsp;\u0026plusmn;\u0026thinsp;7.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.49\u003csup\u003eU\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eThe symbol \u0026lsquo;U\u0026rsquo; indicates the data was analyzed by the unpaired Mann\u0026ndash;Whitney U test; The symbol \u0026lsquo;T\u0026rsquo; indicates the data was analyzed by the unpaired t test; The symbol \u0026lsquo;F\u0026rsquo; indicates the data was analyzed by the Fisher\u0026rsquo;s exact test; The symbol \u0026lsquo;C\u0026rsquo; indicates the data was analyzed by the Chi-square test.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003et-PVP: Traditional puncture percutaneous vertebroplasty; ud-PVP: unilateral dual-plane puncture percutaneous vertebroplasty.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eClinical outcomes\u003c/h2\u003e \u003cp\u003eAlthough there were no significant differences in LKA, AVH, LL, and TLK between the two groups at one year postoperatively (Fig.\u0026nbsp;3), the changes in AVH and LKA from postoperative to one year postoperatively were greater in the traditional group than in the unilateral dual-plane puncture group (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Furthermore, clinical efficacy was assessed using Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). There were no significant differences in preoperative VAS and ODI scores between the two groups. On the first postoperative day, patients in both the traditional and unilateral dual-plane puncture groups experienced significant improvement in pain, with no significant difference between the groups in terms of improvement magnitude. During the 3-month follow-up period, clinical efficacy was comparable between the two groups. However, at 1 year postoperatively, patients in the unilateral dual-plane puncture group exhibited a statistically significant difference in VAS scores, with a mean of 1.26 compared to 2.03 in the traditional group. In terms of ODI scores, patients in the unilateral dual-plane group achieved an average score of 28.58, which was superior to the traditional group's score of 32.45 (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRadiological parameters at one-year postoperative follow-up. (x\u0026thinsp;\u0026plusmn;\u0026thinsp;s, n\u0026thinsp;=\u0026thinsp;145)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003et-PVP (n\u0026thinsp;=\u0026thinsp;71)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eud-PVP (n\u0026thinsp;=\u0026thinsp;74)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLKA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e13.56\u0026thinsp;\u0026plusmn;\u0026thinsp;6.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e13.10\u0026thinsp;\u0026plusmn;\u0026thinsp;6.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.85\u003csup\u003eU\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAVH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e16.05\u0026thinsp;\u0026plusmn;\u0026thinsp;3.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e16.62\u0026thinsp;\u0026plusmn;\u0026thinsp;3.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.28\u003csup\u003eU\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e42.59\u0026thinsp;\u0026plusmn;\u0026thinsp;12.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e44.76\u0026thinsp;\u0026plusmn;\u0026thinsp;13.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.32\u003csup\u003eT\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTLK\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e16.16\u0026thinsp;\u0026plusmn;\u0026thinsp;8.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e13.80\u0026thinsp;\u0026plusmn;\u0026thinsp;7.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.26\u003csup\u003eU\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChanged AVH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.01\u003csup\u003eT\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChanged LKA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.30\u0026thinsp;\u0026plusmn;\u0026thinsp;1.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.32\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.01\u003csup\u003eT\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eThe symbol \u0026lsquo;U\u0026rsquo; indicates the data was analyzed by the unpaired Mann\u0026ndash;Whitney U test; The symbol \u0026lsquo;T\u0026rsquo; indicates the data was analyzed by the unpaired t test; The symbol \u0026lsquo;F\u0026rsquo; indicates the data was analyzed by the Fisher\u0026rsquo;s exact test; The symbol \u0026lsquo;C\u0026rsquo; indicates the data was analyzed by the Chi-square test.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003et-PVP: Traditional puncture percutaneous vertebroplasty; ud-PVP: unilateral dual-plane puncture percutaneous vertebroplasty.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparisons of postoperative VAS and ODI scores between traditional puncture PVP and unilateral dual-plane puncture PVP (x\u0026thinsp;\u0026plusmn;\u0026thinsp;s, n\u0026thinsp;=\u0026thinsp;145)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eVAS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eODI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003et-PVP (n\u0026thinsp;=\u0026thinsp;71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eud-PVP (n\u0026thinsp;=\u0026thinsp;74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003et-PVP (n\u0026thinsp;=\u0026thinsp;71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eud-PVP (n\u0026thinsp;=\u0026thinsp;74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1 day after surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.88\u0026thinsp;\u0026plusmn;\u0026thinsp;0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.28\u003csup\u003eU\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e47.31\u0026thinsp;\u0026plusmn;\u0026thinsp;9.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e45.96\u0026thinsp;\u0026plusmn;\u0026thinsp;9.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.30 \u003csup\u003eU\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1 month after surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.51\u0026thinsp;\u0026plusmn;\u0026thinsp;1.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.41\u0026thinsp;\u0026plusmn;\u0026thinsp;1.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.51\u003csup\u003eU\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e39.62\u0026thinsp;\u0026plusmn;\u0026thinsp;9.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e37.42\u0026thinsp;\u0026plusmn;\u0026thinsp;10.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.09\u003csup\u003eU\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3 months after surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.90\u0026thinsp;\u0026plusmn;\u0026thinsp;1.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.80\u0026thinsp;\u0026plusmn;\u0026thinsp;1.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.58 \u003csup\u003eU\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33.03\u0026thinsp;\u0026plusmn;\u0026thinsp;7.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e31.89\u0026thinsp;\u0026plusmn;\u0026thinsp;9.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.42 \u003csup\u003eT\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1 year after surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.01 \u003csup\u003eU\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32.45\u0026thinsp;\u0026plusmn;\u0026thinsp;7.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e28.58\u0026thinsp;\u0026plusmn;\u0026thinsp;7.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;0.01 \u003csup\u003eU\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eThe symbol \u0026lsquo;U\u0026rsquo; indicates the data was analyzed by the unpaired Mann\u0026ndash;Whitney U test; The symbol \u0026lsquo;T\u0026rsquo; indicates the data was analyzed by the unpaired t test.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003et-PVP: Traditional puncture percutaneous vertebroplasty; ud-PVP: unilateral dual-plane puncture percutaneous vertebroplasty.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eRe-collapse\u003c/h2\u003e \u003cp\u003eSubsequently, we delved into the occurrence of re-collapse following PVP surgery. Within the traditional group, there were 30 cases (42.25%) of re-collapse within 1-year post-injury, significantly higher than the 14 cases (18.92%) observed in the unilateral dual-plane group (Fig.\u0026nbsp;4). This suggests that the unilateral dual-plane puncture technique can significantly reduce the incidence of vertebral re-collapse following PVP surgery. Further stratification was conducted based on whether the bone cement made simultaneous contact with the superior and inferior endplates. Among those in contact with both endplates, the re-collapse rate within 1-year post-injury was merely 3.9%. Conversely, the re-collapse rate post-surgery for cases where the bone cement only contacted one endplate or did not engage with the endplates at all was 60.29% (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). This underscores the superior supportive effect provided by simultaneous contact with the superior and inferior endplates. Subsequently, we analyzed the imaging data of patients who experienced collapse despite contact with the superior and inferior endplates and found that all three cases were in the unilateral dual-plane puncture group. Despite simultaneous contact with the superior and inferior endplates, the adjustment in the angle of the puncture needle led to the bone cement not forming a contiguous structure within the vertebral body but rather a \"bone cement-trabecular bone-bone cement\" structure resembling a sandwich biscuit. This sandwich structure may concentrate stress on the intervening trabecular bone, rendering it prone to collapse. To ascertain whether the unilateral dual-plane puncture group reduced the occurrence of re-collapse by influencing the distribution of bone cement, we performed binary logistic regression analysis. When the puncture method was considered as a single-factor variable, we found a significant association between the puncture method and re-collapse occurrence. However, upon introducing bone cement distribution into the model, the puncture method no longer served as a significant risk factor for re-collapse. This suggests that the unilateral dual-plane puncture may mitigate the risk of vertebral re-collapse by altering the distribution of bone cement.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparisons of the impact of surgical procedure and bone cement distribution on vertebral re-collapse. (x\u0026thinsp;\u0026plusmn;\u0026thinsp;s, n\u0026thinsp;=\u0026thinsp;145)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eNon-recollapse group Re-collapse group p\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical procedure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003et-PVP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e41(57.75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30(42.25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.01\u003csup\u003eF\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eud-PVP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e63(81.08%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14(18.92%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBone cement distribution\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFull Endplate Contact\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e74(96.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3(3.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.01\u003csup\u003eF\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePartial or no Endplate Contact\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27(39.71%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41(60.29%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eThe symbol \u0026lsquo;F\u0026rsquo; indicates the data was analyzed by the Fisher\u0026rsquo;s exact test;\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe incidence of osteoporosis has risen to the seventh position among common diseases worldwide\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. In China, the current elderly population is approximately 130\u0026nbsp;million, with an annual growth rate of 3.2% for individuals aged 60 and above. The prevalence of osteoporosis in China is around 6.6%, affecting a total of 60\u0026ndash;80\u0026nbsp;million individuals, primarily among those aged 60 and above and postmenopausal women\u003csup\u003e[\u003cspan additionalcitationids=\"CR24 CR25\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e. Within the osteoporotic population, approximately 700,000 vertebral compression fractures occur annually, constituting a significant factor leading to disability and even death in the elderly\u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAfter a vertebral compression fracture, the original strength and stiffness of the vertebra are compromised, especially in the collapsed trabeculae within the upper half of the vertebral body. The repair of a fractured vertebra is directly influenced by the amount of bone cement, and an appropriate dosage can directly enhance the stiffness and strength of the operated vertebra, stabilize the vertebra, correct spinal deformities, and prevent further collapse. Cadaveric studies suggest that to restore the compressive strength of a vertebra, at least 15% cement filling is required. In the thoracolumbar spine, this translates to an average injection volume of 4\u0026ndash;6 ml of bone cement per vertebra\u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e. Li et al. found that the average cement usage in patients with re-fractures (3.30\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84 ml) was significantly lower than in those without fractures (4.46\u0026thinsp;\u0026plusmn;\u0026thinsp;1.10 ml)\u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e. Insufficient cement injection may lead to inadequate vertebral filling, insufficient support, and an increased risk of re-collapse. Injecting more cement can allow for a wider dispersion within the trabecular bone clefts, reducing areas without cement support. Therefore, an appropriate high-dose cement can lower the risk of further height loss post-enhancement.\u003c/p\u003e \u003cp\u003eInsufficient bone cement injection is a risk factor for post-PVP vertebral re-collapse, and an adequate amount of bone cement is beneficial for better vertebral height restoration and stability. However, excessive bone cement injection increases the risk of cement leakage, with the potential for disastrous consequences such as nerve compression and severe pulmonary embolism\u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e. Therefore, while ensuring an appropriate amount of bone cement injection, the distribution pattern of bone cement within the vertebra has become a focal point of study for some researchers.\u003c/p\u003e \u003cp\u003eStudies suggest that the distribution of bone cement between the upper and lower endplates of the vertebra is more effective \u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e. When the bone cement fully contacts both the upper and lower endplates, it enhances the restoration of vertebral body strength and preserves vertebral body height more effectively, thereby reducing the risk of vertebral body recompression and long-term pain. Based on this, some physicians adopt the surgical approach of bilateral dual-plane puncture PVP, intending to achieve contact between bone cement and the upper and lower endplates. However, bilateral dual-plane puncture PVP increases surgical time, fluoroscopy frequency, and trauma levels\u003csup\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eWe propose, for the first time, a unilateral dual-plane puncture PVP through the transpedicular route. During puncture, the puncture needle is slightly inclined towards the plane of the upper endplate, reaching the midline of the vertebra through the lateral transpedicular route. Under C-arm guidance, bone cement is injected, and then the puncture needle is withdrawn to the posterior edge of the vertebra. The needle angle is adjusted to incline towards the plane of the lower endplate, and after reaching the midline of the vertebra, an appropriate amount of bone cement is injected. In preliminary studies, we found that unilateral dual-plane puncture PVP significantly increases the contact rate between bone cement and the upper and lower endplates, improving the distribution pattern of bone cement within the vertebra.\u003c/p\u003e \u003cp\u003eAs anticipated, the unilateral dual-plane puncture technique significantly increased the proportion of simultaneous contact between bone cement and the superior and inferior endplates compared to traditional puncture techniques. Simultaneously, it markedly reduced the probability of vertebral re-collapse postoperatively, thereby improving long-term clinical outcomes for patients. However, this does not imply that the unilateral dual-plane puncture technique is devoid of additional risks. We observed that excessive adjustment of the puncture angle in the unilateral dual-plane technique could lead to the formation of a sandwich-like structure comprising bone cement-trabecular bone-bone cement, increasing the likelihood of collapse in the intervening trabecular bone region.\u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eOur study has several limitations. Firstly, we determined the sagittal distribution of bone cement through postoperative spinal X-ray imaging. However, accurate measurements were sometimes challenging due to the obstruction caused by the bone cement. Secondly, the criteria we defined for re-collapse, involving a height decrease exceeding 1 mm and an angle increase greater than 3\u0026deg;, are relatively stringent, potentially leading to false positives. Lastly, solely assessing contact between bone cement and the superior and inferior endplates as a criterion for evaluating sagittal distribution may lack precision. A more comprehensive analysis could be achieved by quantifying the contact area between the bone cement and the endplates; however, this would require follow-up CT data, thereby increasing radiation exposure to patients during follow-up.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe unilateral dual-plane puncture technique can improve the distribution of bone cement within the vertebral body, reducing the incidence of vertebral re-collapse following PVP surgery and enhancing long-term clinical outcomes for patients postoperatively.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e We acknowledge all the participants in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors Contributions:\u003c/strong\u003e Huo-Liang Zheng and Chang-hai Liu wrote the article. Lei-Sheng Jiang, Chang-hai Liu and Huo-Liang Zheng were responsible for data collection and analysis. Sheng-Dan Jiang was responsible for reviewing the data. Xin-Feng Zheng and Sheng-Dan Jiang were responsible for reviewing and revising the article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThis study was supported by the Shanghai Sailing Program (23YF1425900), National Natural Science Foundation of China (82272535), National Natural Science Foundation of China (82302741) and Shanghai Municipal Hospital Development Center (SHDC2022CRD027).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material:\u003c/strong\u003e Data is available from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval:\u0026nbsp;\u003c/strong\u003eThe study was conducted in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments and was approved by the Ethics Committee of Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGopinath V, Osteoporosis. 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Int J Surg (London England). 2022;101:106632.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChevalier Y, Pahr D, Charlebois M, Heini P, Schneider E, Zysset P. Cement distribution, volume, and compliance in vertebroplasty: some answers from an anatomy-based nonlinear finite element study. Spine. 2008;33(16):1722\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang S, Chen C, Wang H, Wu Z, Liu L. A systematic review of unilateral versus bilateral percutaneous vertebroplasty/percutaneous kyphoplasty for osteoporotic vertebral compression fractures. Acta Orthop Traumatol Turc. 2017;51(4):290\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-4470138/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4470138/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose:\u003c/h2\u003e \u003cp\u003eTo evaluate the efficacy of a novel unilateral dual-plane puncture technique in improving bone cement distribution and reducing vertebral re-collapse following percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures (OVCFs).\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eA randomized trial enrolled 145 patients diagnosed with OVCFs, who were then allocated into either traditional or unilateral dual-plane puncture groups. Bone cement distribution, vertebral height and segmental kyphotic angle was measured through postoperative X ray, while clinical outcomes were evaluated using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI).\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eThe unilateral dual-plane puncture technique notably augmented bone cement contact with both superior and inferior endplates compared to conventional methods, achieving rates of 64.86% versus 40.85% (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This contributed to a significant reduction in the incidence of vertebral re-collapse within the first-year post-operation: 18.92% in the unilateral dual-plane group as opposed to 42.25% in the traditional group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Furthermore, the unilateral dual-plane group exhibited markedly superior long-term efficacy, evidenced by mean VAS and ODI scores of 1.26 and 28.58, respectively, in comparison to 2.03 and 32.45 in the traditional group.\u003c/p\u003e\u003ch2\u003eConclusions:\u003c/h2\u003e \u003cp\u003eThe unilateral dual-plane puncture technique advances bone cement distribution within the vertebra, thereby reducing the risk of vertebral re-collapse following PVP surgery and improving long-term clinical outcomes for patients with OVCFs.\u003c/p\u003e","manuscriptTitle":"Unilateral Dual-Plane Puncture percutaneous vertebroplasty Reduces Re-collapse in Osteoporotic Vertebral Compression Fractures by Advancing Cement Delivery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-12 03:38:47","doi":"10.21203/rs.3.rs-4470138/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4e8151f0-fbaa-4725-82f8-5da3a57477e5","owner":[],"postedDate":"June 12th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-07-01T23:36:39+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-12 03:38:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4470138","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4470138","identity":"rs-4470138","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}