Orthopedics

Feature Article 

Short-term Efficacy of the Percutaneous Vertebroplasty Using a Curved Versus Straight Vertebroplasty Needle in Osteoporotic Vertebral Compression Fractures

Zhihua Geng, MM; Quanfa Zhou, MM; Guowei Shang, PhD; Yanhui Ji, PhD; Hongwei Kou, MM; Hongjian Liu, PhD

Abstract

The purpose of this study was to compare the efficacy of the curved puncture approach with 2 conventional approaches in percutaneous vertebroplasty (PVP) for the treatment of single-level osteoporotic vertebral compression fractures. Ninety-six patients with a single-level thoracolumbar vertebral fracture were surgically treated in the authors' department from February 2016 to February 2018. Patients were randomly divided into 3 groups, including 25 patients who had PVP punctured with a curved vertebroplasty needle (group C), 40 patients with unipedicular PVP with a straight vertebroplasty needle (group U), and 31 patients with bipedicular PVP with a straight vertebroplasty needle (group B). The short-term efficacies of PVP using different vertebroplasty needles were compared. Significant differences were tested preoperatively and postoperatively in vertebral body height variation, visual analog scale score, and Oswestry Disability Index in each of the 3 groups (P<.05). There was no significant difference among the groups in terms of Cobb angle correction and bone cement leakage. Group C and group U were superior to group B in terms of operative time and injected cement volume (P<.05). Twenty-four (96.0%) patients in group C and 29 (93.5%) patients in group B had centered cement distribution without significant differences (P>.05), which was superior to group U (P<.05). Curved puncture PVP achieved a satisfactory clinical outcome for osteoporotic vertebral compression fractures, with the advantages of less operative time, less injected cement volume, and more reasonable cement distribution for stabilization of the affected vertebrae. [Orthopedics. 2021;44(1):e131–e138.]

Abstract

The purpose of this study was to compare the efficacy of the curved puncture approach with 2 conventional approaches in percutaneous vertebroplasty (PVP) for the treatment of single-level osteoporotic vertebral compression fractures. Ninety-six patients with a single-level thoracolumbar vertebral fracture were surgically treated in the authors' department from February 2016 to February 2018. Patients were randomly divided into 3 groups, including 25 patients who had PVP punctured with a curved vertebroplasty needle (group C), 40 patients with unipedicular PVP with a straight vertebroplasty needle (group U), and 31 patients with bipedicular PVP with a straight vertebroplasty needle (group B). The short-term efficacies of PVP using different vertebroplasty needles were compared. Significant differences were tested preoperatively and postoperatively in vertebral body height variation, visual analog scale score, and Oswestry Disability Index in each of the 3 groups (P<.05). There was no significant difference among the groups in terms of Cobb angle correction and bone cement leakage. Group C and group U were superior to group B in terms of operative time and injected cement volume (P<.05). Twenty-four (96.0%) patients in group C and 29 (93.5%) patients in group B had centered cement distribution without significant differences (P>.05), which was superior to group U (P<.05). Curved puncture PVP achieved a satisfactory clinical outcome for osteoporotic vertebral compression fractures, with the advantages of less operative time, less injected cement volume, and more reasonable cement distribution for stabilization of the affected vertebrae. [Orthopedics. 2021;44(1):e131–e138.]

One osteoporosis fracture occurs every 3 seconds in the world.1 Among them, osteoporotic vertebral compression fractures (OVCF) are the most common, exceeding 500,000 annually in the United States.2 Osteoporotic vertebral compression fractures can cause a variety of outcomes, including sudden back pain, morphological changes, disability, and poor quality of life, and can even affect the survival rate of patients.3 Since the first application of percutaneous vertebroplasty (PVP) in 1984, where a bone puncture needle was percutaneously inserted into an injured vertebral body for bone cement infusion to reinforce the injured vertebra by Galibert et al,4 PVP has been widely used in the treatment of OVCFs in the elderly.

Conventional puncture approaches in PVP include unilateral puncture PVP and bilateral puncture PVP, which have advantages and disadvantages. Compared with bipedicular PVP, unipedicular PVP entails a shorter operative time and lower radiograph irradiation.5 However, Liu et al6 showed that a bipedicular approach could help improve cement distribution and reduce the epidural cement leakage rate over a unipedicular approach in OVCF of the midthoracic vertebrae. The selection of these 2 surgical methods is still controversial.7–9 By improving the defect of the traditional unipedicular puncture and bilateral puncture PVP, the curved puncture approach of PVP, using the ultra-high elasticity of Nitinol (Biological Technology of Ningbo Huakerun Co, Ltd), could reach a wider area of the vertebrae, which the right-angle metal sleeve could not reach. As an improved PVP device, the curved vertebroplasty device (SV110-3712; Biological Technology of Ningbo Huakerun Co, Ltd), which punctures through the unilateral vertebral pedicle where bone cement is injected into both sides of the vertebral body, can theoretically combine the advantages of the former 2 (FG3002; Shanghai Kinetic Medical Co, Ltd) through unilateral pedicle puncture, achieving the bilateral reinforcement. The clinical efficacy of the device for OVCFs has rarely been reported in the literature; therefore, the authors conducted a study in their hospital to evaluate the efficiency of the curved puncture approach vs the 2 conventional approaches in PVP for the treatment of single-level OVCFs.

Materials and Methods

The study protocol received institutional review board and ethics committee approval. Patients gave written consent after full explanation of the therapeutic procedure.

Inclusion and Exclusion Criteria

Inclusion criteria were as follows: (1) age older than 55 years; (2) lumbar spine bone mineral density (BMD) T-score less than 2.5; (3) main complaint of obvious back pain; (4) radiograph showing a wedge-shaped vertebral body, computed tomography (CT) scan showing the complete posterior margin of the vertebral body or no free bone mass, or magnetic resonance image (MRI) showing only a single vertebral body with fresh fracture (ie, there is an apparent bone edema in the fractured vertebra by a hypointensive signal on T1-weighted images and hyperintensive signal on T2-weighted images on MRI); (5) physical examination indicating that the diseased location is consistent with the imaging location; and (6) bilateral pedicle intact without fracture.

Exclusion criteria were as follows: (1) severe cardiopulmonary insufficiency; (2) difficult to correct coagulation disorders; (3) systemic infection and local osteomyelitis; (4) vertebral fracture caused by an osteolytic tumor; (5) symptoms of spinal cord compression; and (6) lack of patient consent.

Grouping

From February 2016 to February 2018, 279 patients were screened using the inclusion criteria, and 96 patients with a single-level OVCF were included in this study. According to different surgical methods, they were divided into a unilateral PVP group (group U), unilateral PVP group (group B), and curved PVP group (group C). Randomization was achieved by a computer. All procedures were performed by a highly qualified surgeon (H.L.).

Surgical Procedures

Unilateral Puncture PVP Group. Patients were placed in a prone position, and preoperative vertebral pedicle localization was performed with local anesthesia and unilateral pedicle puncture. When the puncture needle tip reached the junction of the middle and anterior third of the affected vertebral body, the puncture was stopped, the needle core was pulled out, the guide needle was put in, and the working channel was established under the guidance of the guide needle. The puncture needle was then removed, and the bone cement–conveying catheter was placed in the working channel. With the bone cement in the wire drawing state, the injection began; while injecting the high-viscosity polymethyl methacrylate (PMMA) bone cement, the delivery catheter was slowly withdrawn, and this completed the bone cement perfusion of the ipsilateral vertebrae. Surgery was performed under fluoroscopy of a C-arm radiograph machine. When the bone cement solidified, the working channel was removed, and the puncture was pressurized for 10 minutes and then routinely wrapped (Figure 1A–C).

Unilateral puncture device (A): positive radiograph before (B) and after (C) injection of polymethyl methacrylate (PMMA). Bilateral puncture device (D): positive radiograph before (E) and after (F) injection of PMMA. Curved puncture device (G): positive radiograph before (H) and after (I) injection of PMMA.

Figure 1:

Unilateral puncture device (A): positive radiograph before (B) and after (C) injection of polymethyl methacrylate (PMMA). Bilateral puncture device (D): positive radiograph before (E) and after (F) injection of PMMA. Curved puncture device (G): positive radiograph before (H) and after (I) injection of PMMA.

Bilateral Puncture PVP Group. The bilateral PVP procedure was generally the same as the unilateral PVP procedure, but performed on both sides of the vertebra (Figure 1D–F).

Curved Puncture PVP Group. Patients were placed in the prone position, and preoperative vertebral pedicle localization was performed with local anesthesia and unilateral pedicle puncture. When the puncture needle tip reached the anterior third of the vertebral body, the puncture was stopped, the needle core was pulled out, the guide needle was put in, and the working channel was established under the guidance of the guide needle. The puncture needle was inserted into the working channel, and the needle was straight when passed through the channel. After the tip penetrated the channel, its original radian was gradually restored. The puncture of the vertebral body was completed, and the conveying channel of bone cement from the opposite side to the ipsilateral side was established. The curved puncture needle was then removed, and the bone cement–conveying catheter was placed in the working channel to the opposite side of the vertebral body. With the bone cement in the wire drawing state, the injection began; while injecting the high-viscosity PMMA bone cement, the delivery catheter was slowly withdrawn, and this successively completed the bone cement perfusion of the contralateral, middle, and ipsilateral vertebrae. Surgery was performed under fluoroscopy of a C-arm radiograph machine. When the bone cement solidified, the working channel was removed, and the puncture was pressurized for 10 minutes and then routinely wrapped (Figure 1G–I).

Postoperative Treatment

Patients were allowed to move freely 24 hours after surgery. They were required to wear a waist protector for 3 months when getting out of bed and advised to have a postoperative review at 3, 6, 12, and 24 months. All patients were given anti-osteoporosis treatment for half a year.

Observation Indicators

During the operation, bone cement injection volume was recorded. Anterior and middle vertebral body height variation (calculated by fractured vertebral body height/the equivalent values for the adjacent superior and inferior nonfractured vertebrae×100%), Oswestry Disability Index (ODI) scores, and visual analog scale (VAS) scores before surgery and 2 days and 3 months after surgery (VAS score: 0 points, no pain; 3 points or less, slight pain, can be tolerated; 4–6 points, pain influences sleep, can still bear; 7–10 points, progressive strong pain, unbearable, affecting appetite and sleep) were also recorded. Anterior and middle vertebral height was defined as the distance between the upper and lower endplates at the anterior and middle vertebral body wall and in the center of the vertebral body. The angle of vertebral kyphosis was measured as the intersection angle of the perpendicular line of the upper and lower endplates on the lateral radiograph. The Cobb angle correction was the preoperative kyphosis angle minus the postoperative kyphosis angle. A 64-slice spiral CT scan was used to investigate cement leakage after PVP.

After surgery, a 64-slice spiral CT machine was used to perform continuous tomography on the surgical vertebral body, and the plane with the largest area of bone cement distribution in the CT scan was selected for planar division. If 10% of the total area of bone cement crosses the midline of the compression fractured vertebral body, it is considered central cement distribution. If not, it is considered noncentral distribution. The number and proportion of the vertebral bodies with centered distribution in the 3 groups were calculated.

Statistical Analysis

All data were entered into an Excel worksheet (Microsoft), and statistical analysis was performed using SPSS, version 18.0, software (IBM). All measurement data were collected by an independent observer and expressed as mean±SD for descriptive data. The level of statistical significance was defined as P<.05. If the comparison between the 3 groups was statistically significant, Bonferroni and Tamhane correction were used for the within-group comparison. The chi-square test was used to analyze the difference in sex, preoperative bone cement distribution, postoperative bone cement leakage, and bone cement distribution among groups.

Sample size was predicted by an internet-based tool, with 1-beta being 0.9 and alpha being 0.05 ( http://powerandsample-size.com/Calculators; HyLown Consulting LLC). The F-test or Kruskal–Wallis one-way analysis of variance test was used to distinguish the difference in age, BMD, injected cement volume, operative time, preoperative and postoperative anterior and middle vertebral body height variation, Cobb angle correction, and VAS and ODI scores among groups. The paired t test or the Wilcoxon test was used to assess the difference of preoperative and postoperative anterior and middle vertebral body height variation, Cobb angle correction, and VAS and ODI scores within groups.

Results

All patients successfully completed surgery; no patients showed bone cement adverse reactions or any cardiovascular or cerebrovascular events. No significant difference in terms of sex (P>.05, chi-square test; Table 1), age (P>.05, Kruskal–Wallis one-way analysis of variance test; Table 1), BMD T-scores (P>.05, Kruskal–Wallis one-way analysis of variance test; Table 1), and preoperative fracture vertebral distribution (P>.05, chi-square test; Table 1) were found among the 3 groups.

Comparison of Sex, Age, Bone Mineral Density, and Fracture Vertebral Body Distribution

Table 1:

Comparison of Sex, Age, Bone Mineral Density, and Fracture Vertebral Body Distribution

There was no significant difference in the anterior vertebral body height variation among the 3 groups preoperatively (P>.05, Kruskal–Wallis one-way analysis of variance test; Table 2), 2 days postoperatively (P>.05, Kruskal–Wallis one-way analysis of variance test; Table 2), and 3 months postoperatively (P>.05, Kruskal–Wallis one-way analysis of variance test; Table 2). The anterior vertebral body height variation 2 days postoperatively (P<.05, Wilcoxon test; Table 3) and 3 months postoperatively (P<.05, Wilcoxon test; Table 2) were significantly higher than those preoperatively within the 3 groups, and the difference was statistically significant. The authors also found similar results in middle vertebral body height variation among the 3 groups.

Comparison of the Vertebral Body Height Variation in Each Group

Table 2:

Comparison of the Vertebral Body Height Variation in Each Group

Comparison of Preoperative Patient Data

Table 3:

Comparison of Preoperative Patient Data

Similarly, there was no significant difference in the Cobb angle correction among the 3 groups preoperatively (P>.05, F-test; Table 4, Figure 2A), 2 days postoperatively (P>.05, F-test; Table 4), and 3 months postoperatively (P>.05, F-test; Table 4, Figure 2A). The Cobb angle correction 2 days postoperatively (P<.05, Wilcoxon test; Table 4, Figure 2A) and 3 months postoperatively (P<.05, Wilcoxon test; Table 4, Figure 2A) were significantly higher than those preoperatively within the 3 groups, and the difference was statistically significant. The authors also found similar results in the VAS and ODI scores among the 3 groups (Figure 2B–C, Table 4).

Comparison of Cobb Angles, Visual Analog Scale Scores, and Oswestry Disability Index Scores

Table 4:

Comparison of Cobb Angles, Visual Analog Scale Scores, and Oswestry Disability Index Scores

Comparison of the Cobb angle correction in each group. ***Compared with the same group before operation (OP) (P<.05) (A). Comparison of the visual analog scale score before and after surgery in each group. ***Compared with the same group before OP (P<.05) (B). Comparison of the Oswestry Disability Index scores before and after surgery in each group. ***Compared with the same group before OP (P<.05) (C).

Figure 2:

Comparison of the Cobb angle correction in each group. ***Compared with the same group before operation (OP) (P<.05) (A). Comparison of the visual analog scale score before and after surgery in each group. ***Compared with the same group before OP (P<.05) (B). Comparison of the Oswestry Disability Index scores before and after surgery in each group. ***Compared with the same group before OP (P<.05) (C).

Significant differences were found in the operative time and injected cement volume among the 3 groups. There was no difference in operative time (P>.05, F-test; Table 3) between the curved PVP group (38.47±3.59 minutes; Table 3) and the unilateral PVP group (39.61±4.48 minutes; Table 3), but the differences were both statistically significant (P<.05, F-test; Table 3) compared with the bilateral PVP group (55.42±5.72 minutes; Table 3). Similarly, there was no difference in the injected cement volume (P>.05, F-test; Table 3) between the curved PVP group (3.54±0.35 mL; Table 2) and the unilateral PVP group (3.46±0.33 mL; Table 3), but the differences were both statistically significant (P<.05, F-test; Table 3) compared with the bilateral PVP group (5.06±0.37 mL; Table 3).

There were 12 cases of bone cement leakage among the 96 patients, without clinical symptoms: 4 cases in the unilateral PVP group, 6 cases in the bilateral PVP group, and 2 cases in the curved PVP group. No difference was found among the 3 groups (P>.05, chi-square test; Table 3).

The vertebral body with centered bone cement distribution accounted for 65.0% (26 of 40) in the unilateral PVP group, 93.5% (29 of 31) in the bilateral PVP group, and 96.0% (24 of 25) in the curved PVP group. There was no difference between the bilateral PVP group and the curved PVP group (P>.05, chi-square test; Table 3), whereas significant differences were found when compared with the uni-lateral PVP group (P<.05, chi-square test; Table 3).

Discussion

In this prospective, randomized study, all 3 PVP groups achieved satisfactory results, and patients' clinical outcome parameters (vertebral body height variation, VAS and ODI scores, and Cobb angle correction) were significantly improved postoperatively. The improvement in the clinical outcomes and bone cement leakage rate were not significantly different among the 3 groups under the strict inclusion criteria. The curved puncture approach (group C) and unilateral puncture approach (group U) were superior to the bilateral puncture approach (group B) in terms of operative time and injected cement volume. The curved puncture approach (group C) and bilateral puncture approach (group B) had centered cement distribution without significant differences, which were superior to the unilateral puncture approach (group U).

In treating OVCF, minimally invasive methods such as percutaneous balloon kyphoplasty (PKP) and nerve block were also introduced. The effectiveness of PKP in treating OVCF has been reported,10–12 but with longer operative time and a higher material cost compared with PVP.13 Also, nerve block by breaking the cycle could reduce the pain, which has a lower risk and is less costly, but without restoration of vertebral height and correction of segmental kyphosis.14 In the authors' department, PVP was preferred due to its cost-effectiveness in treating OVCF.

According to a study by Fu et al,15 there was a positive dose-response correlation of cement volume with the incidence of cement leakage and the degree of pain relief after PVP, respectively. Li et al16 found that patients with low BMD undergoing PKP or receiving a low volume of injected cement have a higher risk of recollapse in surgical vertebrae. Zhu et al17 found that high-dose bone cement injection is one of the important independent risk factors for postoperative cement leakage. Kim et al18 reported that when the cement perfusion amount exceeds 30% of the vertebral body volume, it is enough to restore the stiffness before vertebral fracture. However, Martincic et al9 believed that a cement perfusion amount of at least 15% of the vertebral body volume could achieve the purpose of improving the mechanical properties of the vertebral body. Thus, the cement injected into the verte-brae should be in the right amount during the PVP procedure, which could result in the best relief pain with the least risk of leakage. The current study showed that group C and group U injected less bone cement than group B, which is consistent with previous literature; however, the risk of leakage between group B and group U was not significant.19,20

In the current study, a 64-slice spiral CT scan was used to investigate the cement leakage after PVP. The bone cement leakage rate was not significantly different among the 3 groups, which was in accordance with previous studies.5,20 However, other studies showed that the cement leakage at the unilateral level was significantly less than at the bilateral level.6,19 By comparison, the study by Liu et al6 did not exclude the effect of surgical procedure on the cement leakage rate (some patients by PKP, others by PVP); the vertebral fracture pattern may also impact cement leakage.21,22

No difference in the anterior and middle vertebral body height variation was found among the 3 groups preoperatively, 2 days postoperatively, and 3 months postoperatively. The anterior and middle vertebral body height variation 2 days postoperatively and 3 months postoperatively were significantly higher than those preoperatively within the 3 groups. The results were similar to those in a study by Zhang et al,5 as well as the Cobb angle. However, Yan et al19 found that the uni-lateral level achieved more postoperative Cobb angle correction than the bilateral level; in their study, bone cement distributed mainly in the anterior and middle of the vertebral body.

According to several previous studies, the asymmetric or insufficient distribution of bone cement around the vertebral fracture area could affect pain relief and even cause recollapse of the vertebral body. A study by Chen et al23 agreed that when cement augmentation crosses the midline of the compression fractured vertebral body, stiffness of both sides increased comparatively and biomechanical balance was thus achieved. Liu et al6 suggested that a bipedicular approach could help improve cement distribution when compared with an unipedicular approach in OVCF of the midthoracic vertebrae. A higher incidence of recompression in cemented vertebrae was seen in patients with treated vertebrae exhibiting a uninterlocked solid pattern or discontinuous trabecular pattern.24 A study by Zhang et al25 indicated that patients with bone cement distributed around both the upper and lower endplates had a lower risk of recompression when compared with patients with bone cement distributed in the middle of the vertebral body, which means the insertion of the 2 needles could help the filling of the cement. Kim et al26 suggested that unipedicular access is sufficient for homogeneous cement distribution, but to pursue symmetric distribution of bone cement, the abduction angle of the puncture requires forceful increasing, which could lead to injury of the inner wall of the pedicle and the nerve. In accordance with previous studies, cement distribution in the current study was centered in both group C and group B without any significant differences, which was superior to group U.

Group C and group U were superior to group B in terms of operative time, which agreed with several previous studies.5,19 Due to the long duration of bilateral intensive surgery, elderly patients with chronic obstructive pulmonary disease, diabetes mellitus, coronary heart disease, and hypertension may be unable to tolerate the operative time of the bilateral puncture.

This study indicated no significant difference in VAS and ODI scores postoperatively despite the aforementioned priorities of the curved vertebroplasty needle. Several previous studies also showed no significant difference in VAS or ODI scores between unilateral and bilateral punctures after up to 2 years of observation.5,20 Given the results of better cement placement, reduced injected cement volume, and less operative time in the curved puncture group, the authors suppose that optimized clinical results might be achieved. It is hypothesized that differences in VAS and ODI scores might be found after mid- or long-term observation, or with a larger sample size. Further study will be performed in the future. Moreover, factors such as different sensitivities to pain and patients' expectations need to be included.

Most clinical studies have demonstrated the efficacy of PVP in the treatment of OVCF.5,27 In this study, 3 puncture approaches of PVP were safe and effective in the treatment of OVCF. The unilateral puncture approach and the curved puncture approach entails a shorter operative time and less cement volume than the bilateral puncture approach. An excessive amount of cement is also required in the bilateral surgery, which may lead to bone cement leakage. The bilateral puncture approach and curved puncture approach ensured the symmetrical distribution of bone cement compared with the unilateral puncture approach, where uneven distribution of bone cement could result in uneven weight bearing, causing instability of the entire spine. Thus, in the authors' opinion, the curved puncture approach with PVP could shorten the operative time and the volume of bone cement while achieving bilateral reinforcement of the fractured vertebral body and improving the stability of the fractured vertebral body. Thus, it is feasible and effective to treat OVCF with PVP through a curved vertebroplasty device. However, further long-term follow-up should be introduced.

This study had several shortcomings. First, it was from a single hospital with a limited number of patients, which may have caused bias. Second, this study reported a short-term result. In the future, mid-term and long-term outcomes with more patients should be reported.

Conclusion

Curved puncture PVP can achieve a satisfactory clinical outcome for OVCF. It has the advantages of less operative time, less injected cement volume, and more reasonable cement distribution for stabilization of the affected vertebrae.

References

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Comparison of Sex, Age, Bone Mineral Density, and Fracture Vertebral Body Distribution

GroupaNo. male/femaleMean±SDNo. bone cement distribution


Age, yBone mineral density T-scoreT10T11T12L1L2L3L4L5
U14/2670.6±4.8−3.16±0.36139126432
B10/2170.4±6.6−3.23±0.4512984421
C8/1770.7±6.8−3.14±0.4211495221
P.958b.154.120.999c

Comparison of the Vertebral Body Height Variation in Each Group

Time/parameterMean±SDPb

Group Ua (n=40)Group Ba (n=31)Group Ca (n=25)
Preoperative
  Anterior vertebral body height variation40.7%±6.5%42.0%±9.3%42.9%±3.4%.204
  Middle vertebral body height variation46.8%±5.0%48.7%±7.2%48.8%±5.1%.368
2 days postoperative
  Anterior vertebral body height variation55.3%±6.5%c58.6%±5.3%d57.3%±6.2%e.186
  Middle vertebral body height variation60.1%±5.1%c60.1%±4.4%d60.0%±4.2%e.912
3 months postoperative
  Anterior vertebral body height variation54.4%±4.9%c56.1%±5.3%d53.8%±6.2%e.325
  Middle vertebral body height variation56.3%±5.3%c55.6%±5.6%d57.2%±6.1%e.518

Comparison of Preoperative Patient Data

GroupaMean±SDCement leakage rate (no./total no.)Proportion of vertebral bodies with centered distribution of bone cement (no./total no.)

Operative time, minInjected bone cement volume, mL
U39.61±4.48b3.46±0.33b10.0% (4/40)65.0% (26/40)b
B55.42±5.725.06±0.3719.4% (6/31)93.5% (29/31)
C38.47±3.59b,c3.54±0.35b,c8.0% (2/25)96.0% (24/25)d,e
P.001.001.364f.001g

Comparison of Cobb Angles, Visual Analog Scale Scores, and Oswestry Disability Index Scores

Parameter/timeMean±SDP

Group Ua (n=40)Group Ba (n=31)Group Ca (n=25)
Cobb angle
  Preoperative16.45°±6.55°16.91°±5.62°17.12°±6.53°.906
  2 days postoperative11.16°±6.10°b10.65°±5.53°b12.04°±5.69°b.672
  3 months postoperative10.89°±6.25°b,c10.65°±5.44°b,c11.36°±5.96°b,c.904
Visual analog scale score
  Preoperative7.9±0.67.9±0.57.7±0.5.178
  2 days postoperative2.4±0.4b2.4±0.4b2.3±0.5b.777
  3 months postoperative2.4±0.6b,c2.5±0.3b,c2.4±0.5b,c.370
Oswestry Disability Index score
  Preoperative40.1±3.540.1±4.740.2±5.2.994
  2 days postoperative19.4±3.6b20.8±4.6b20.1±3.5b.343
  3 months postoperative20.5±3.9b,c20.3±4.7b,c19.0±4.7b,c.358
Authors

The authors are from the Department of Orthopaedics (ZG, GS, YJ, HK, HL), the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, and the Department of Orthopaedics (QZ), the First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang, China.

The authors have no relevant financial relationships to disclose.

Correspondence should be addressed to: Hongjian Liu, PhD, Department of Orthopaedics, the First Affiliated Hospital of Zhengzhou University, No. 1 Longhu Middle Ring Rd, Jinshui District, Zhengzhou, Henan 450052, China ( hongjianmd2017@sina.com).

Received: May 22, 2019
Accepted: October 24, 2019
Posted Online: November 03, 2020

10.3928/01477447-20201012-03

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