The puncture methods of extrapedicular PVP (PKP): A narrative review

Abstract Backgroud A variety of extrapedicular puncture methods have been successfully used in percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP). Currently, there are no reviews on extrapedicular puncture. Authors reviewed the puncture methods in different extrapedicular approaches and recommend appropriate extrapedicular puncture methods for thoracolumbar PVP (PKP). Methods All the published research available in English and Chinese up to January 2020 from Web of Science, PubMed, Embase, China National Knowledge Internet (CNKI), and the Wanfang Database were included. The subject areas included “percutaneous vertebroplasty, percutaneous kyphoplasty, vertebral augmentation” and “extrapedicular, parapedicular, bilateral, and unilateral”. Articles met the selection criteria if they contained the details of the puncture method of the extrapedicular approach. Results We searched 118 studies, and after careful reading, 9 studies introduced 10 types of extrapedicular punctures in detail: the transcostovertebral approach, extrapedicular approach, unilateral extrapedicular approach, far-lateral extrapedicular approach, parapedicular access, lumbar extrapedicular approach, thoracic infrapedicular approach, extrapedicular modified inferior endplate access, extrapedicular approach along the predetermined individualized puncture route, and Kambin triangle approach. Conclusions In thoracic vertebrae, the extrapedicular approach could be a better puncture method. In the upper lumbar vertebrae, the unilateral extrapedicular and far-lateral extrapedicular approach are recommended as the extrapedicular puncture methods. In L4-5, extrapedicular puncture is not recommended because of the high risk of injury to the lumbar artery.