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CC BY 4.0 · Indian Journal of Neurosurgery 2025; 14(01): 052-058
DOI: 10.1055/s-0044-1800829
Original Article

Comparative Efficacy of Unilateral vs. Bilateral Approaches in Percutaneous Kyphoplasty and Vertebroplasty for Osteoporotic Vertebral Compression Fractures

Hidayet Safak Cine 
1   Department of Neurosurgery, Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Turkey
,
Ece Uysal 
2   Department of Neurosurgery, University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Turkey
,
Mohammed Aladdam 
1   Department of Neurosurgery, Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Turkey
,
Emre Herdan 
1   Department of Neurosurgery, Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Turkey
,
Mehmet Emre Gunaydin 
2   Department of Neurosurgery, University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Turkey
,
Huseyin Demir 
3   Department of Neurosurgery, Istanbul Aydin University, Istanbul, Turkey
,
Numan Karaarslan 
1   Department of Neurosurgery, Istanbul Medeniyet University, Prof. Dr. Suleyman Yalcin City Hospital, Turkey
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Abstract

Background

Osteoporotic vertebral compression fractures (OVCFs) significantly affect the quality of life of elderly patients by causing severe pain and functional loss. Percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP) are minimally invasive surgical techniques for the treatment of OVCFs. It can be performed unilaterally or bilaterally for prevention of kyphosis without morbidity. This study aims to compare the radiological and clinical outcomes of unilateral versus bilateral approaches in PKP/PVP procedures.

Methods

This retrospective observational study included 230 unilateral (n = 110) and bilateral (n = 120) patients from three spinal centers who underwent PCP or PVP for OVCF treatment between 2018 and 2024. During the operation, operative time, cement volume, and frequency of fluoroscopy were recorded. The duration of hospital stay was recorded. Visual Analog Scale (VAS) scores and Oswestry Disability Index (ODI) scores were used for clinical evaluation at preoperative, postoperative day 1, and final follow-up. Vertebral height and kyphotic angle were used for radiological evaluation.

Results

The unilateral approach had significantly shorter operative times (43.4 ± 9.01 minutes, p < 0.001) compared to the bilateral approach (59.9 ± 11.5 minutes), required less cement (4.44 ± 1.01 mL vs. 7.53 ± 0.911 mL, p < 0.001), and had fewer fluoroscopy (26.2 ± 6.58 vs. 55.6 ± 9.98, p < 0.001). There were no significant differences between the two groups in VAS scores (p = 0.663), ODI scores (p = 0.650), vertebral height restoration (p = 0.720), or kyphotic angle correction (p = 0.129). However, the bilateral group had a higher rate of cement leakage (35 vs. 12%, p = 0.035).

Conclusion

These findings suggest that the unilateral approach offers procedural advantages without compromising clinical efficacy, making it a preferable option for elderly patients with OVCFs.

Keywords

bilateral approach - osteoporotic vertebral compression fractures - percutaneous kyphoplasty - vertebroplasty - unilateral approach

Data Availability Statement

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.


Ethical Approval Statement

Ethical approval was obtained from the Istanbul Medipol University ethical board.


Authors' Contribution

E.U., H.S.C., E.H., and M.A. conceived the study. E.U., H.S.C., N.K., and M.A. developed the methodology. H.S.C., M.E.G., and M.A. performed formal analysis and investigation. E.U., E.H., and H.D. prepared the original draft of the manuscript. E.U., H.S.C., and N.K. reviewed and edited the manuscript.




Publication History

Article published online:
30 December 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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