Can a unilateral approach replace the bilateral approach in percutaneous kyphoplasty?

Abstract

Aims: The main techniques used in balloon kyphoplasty include bilateral and unilateral approaches, but debate continues regarding their effectiveness. This study primarily aims to evaluate the clinical effects and safety profiles of unilateral and bilateral balloon kyphoplasty in osteoporotic and traumatic vertebral compression fractures and to compare patient satisfaction. The study's secondary aim is to identify the factors affecting prognosis, if any, in the general patient population. Our study compared the clinical and radiological results of patients with thoracolumbar vertebra fractures who underwent bilateral and unilateral balloon kyphoplasty operations in general and separately for patient subgroups. Methods: Patients who underwent balloon kyphoplasty at the Neurosurgery Department of Atatürk Training and Research Hospital were investigated retrospectively and called for outpatient clinic control. Their current condition and satisfaction were evaluated. Clinically, patient satisfaction was assessed using a three-point Likert scale, Roland-Morris Disability Questionnaire, and VAS (Visual Analog Scale), and radiologically, preoperative, early postoperative, and late postoperative images in the sagittal plane, vertebral kyphosis angle, segmental kyphosis angle, Beck index, height loss, and axial canal compressions were examined and evaluated comparatively. Results: A total of 77 patients who could be contacted and who were able to access the outpatient clinic were included in the study. Sixty-seven of the patients underwent unilateral surgery, and ten patients underwent bilateral surgery. In the final control, patients who underwent bilateral kyphoplasty had less height loss than patients who underwent unilateral kyphoplasty. There was no difference in other radiological outcomes. There was no significant difference in clinical outcomes between patients who underwent bilateral and unilateral kyphoplasty. Mean Visual Analogue Scale and Roland Morris scores at the final follow-up were significantly higher in female patients than in male patients. Conclusion: There was no statistically significant difference in the satisfaction of patients who underwent bilateral kyphoplasty compared to unilateral kyphoplasty. This result may be due to the small number of patients in the study, and more extensive series are needed. The fact that the clinical results of female patients are worse than those of male patients may be a guide to giving realistic answers to the questions of patients' prognosis and pain expectations in the postoperative period.

Keywords

• Kyphoplasty
• unilateral approach
• bilateral approach
• vertebral compression fractures

Supporting Institution

The author declares that this study has received no financial support.

Project Number

1402573

Ethical Statement

Ethic The Study was initiated with approval of the Katip Celebi University Ataturk Training and Research Hospital Ethics Committee(Date:27/03/2019, Decision No:131) In this study, national and international ethical rules are observed.

References

1. Phillips FM, Ho E, Campbell-Hupp M, Mcnally T, Wetzel FT, Gupta P. Early radiographic and clinical results of balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures. Spine. 2003;28(19):2260-2265.
2. Ma XL, Xing D, Ma JX, Xu WG, Wang J, Chen Y. Balloon kyphoplasty versus percutaneous vertebroplasty in treating osteoporotic vertebral compression fracture: grading the evidence through a systematic review and meta-analysis. Eur Spine J. 2012;21(9):1844-1859. doi:10.1007/s00586-012-2441-6
3. Yang H, Liu T, Zhou J, Meng B, Wang G, Zhu X. Kyphoplasty versus vertebroplasty for painful osteoporotic vertebral compression fractures-which one is better? A systematic review and meta-analysis. Int J Spine Surg. 2013;7:e45-e57. doi:10.1016/j.ijsp.2013.03.001
4. Jay B, Ahn SH. Vertebroplasty. Semin Intervent Radiol. 2013;30(3):297-306.
5. Belkoff SM, Mathis JM, Fenton DC, Scribner RM, Reiley ME, Talmadge K. An ex vivo biomechanical evaluation of an inflatable bone tamp used in the treatment of compression fracture. Spine. 2001;26(2):151-156.
6. Kasper DM. Kyphoplasty. Semin Intervent Radiol. 2010;27(2):172-184. doi:10.1055/s-0030-1253515
7. Kado DM, Duong T, Stone KL, et al. Incident vertebral fractures and mortality in older women: a prospective study. Osteoporosis Int. 2003;14(7):589-594.
8. Jalava T, Sarna S, Pylkkanen L, Pylkkanen P, Mawer B, Kanis JA, et al. Association between vertebral fracture and increased mortality in osteoporotic patients. J Bone Miner Res. 2003;18(7):1254-1260.

9. Svedbom A, Hernlund E, Ivergård M, et al. Osteoporosis in the European Union: a compendium of country-specific reports. Arch Osteoporos. 2013;8(1):137.
10. Lindsay R, Silverman SL, Cooper C, et al. Risk of new vertebral fracture in the year following a fracture. JAMA. 2001;285(3):320-323.
11. Chen CM, Chen L, Gu Y, et al. Kyphoplasty for chronic painful osteoporotic vertebral compression fractures via unipedicular versus bipedicular approachment: a comparative study in early stage. Injury. 2010;41(4):356-359.
12. Huang Z, Wan S, Ning L, Han S. Is unilateral kyphoplasty as effective and safe as bilateral kyphoplasties for osteoporotic vertebral compression fractures? A meta-analysis. Clin Orthop Relat Res. 2014;472(9):2833-2842. doi:10.1007/s11999-014-3745-0
13. Chen H, Tang P, Zhao Y, Gao Y, Wang Y. Unilateral versus bilateral balloon kyphoplasty in the treatment of osteoporotic vertebral compression fractures. Orthopedics. 2014;37(9):e828-e835. doi:10.3928/01477447-20140825-61
14. Steinmann J, Tingey CT, Cruz G, Dai Q. Biomechanical comparison of unipedicular versus bipedicular kyphoplasty. Spine (Phila Pa 1976). 2005;30(2):201-205. doi:10.1097/01.brs.0000150831.46856.87
15. Rebolledo BJ, Gladnick BP, Unnanuntana A, Nguyen JT, Kepler CK, Lane JM. Comparison of unipedicular and bipedicular balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures: a prospective randomised study. Bone Joint J. 2013;95-B(3):401-406. doi:10.1302/0301-620X.95B3.29819
16. Chen B, Li Y, Xie D, Yang X, Zheng Z. Comparison of unipedicular and bipedicular kyphoplasty on the stiffness and biomechanical balance of compression fractured vertebrae. Eur Spine J. 2011;20(8):1272-1280. doi:10.1007/s00586-011-1744-3
17. Chang W, Zhang X, Jiao N, et al. Unilateral versus bilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures. Medicine. 2017;96(17):e6738.
18. Feng H, Huang P, Zhang X, Zheng G, Wang Y. Unilateral versus bilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures: a systematic review and meta-analysis of RCTs. J Orthop Res. 2015;33(11):1713-1723.
19. Yilmaz A, Cakir M, Yucetas CS, et al. Percutaneous kyphoplasty: is bilateral approach necessary? Spine. 2018;43(14):977-983.
20. Wang C, Zhang X, Liu J, Shan Z, Li S, Zhao F. Percutaneous kyphoplasty: risk factors for recollapse of cemented vertebrae. World Neurosurg. 2019;130:e307-e315.