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.