Bilateral Balloon Kyphoplasty Research Articles

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

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.

Unilateral Versus Bilateral Balloon Kyphoplasty for Osteoporotic Vertebral Compression Fractures: A Systematic Review of Overlapping Meta-analyses

Background: There have been many meta-analyses and systematic reviews that have discussed the differences between unilateral and bilateral balloon kyphoplasty. However, their conclusions regarding the efficacy and safety of bilateral balloon kyphoplasty in the treatment of osteoporotic vertebral compression fractures (OVCFs) are discordant. Objective: We attempted to select the best evidence review to determine the differences between unilateral and bilateral balloon kyphoplasty, and we wanted to determine the best treatment approach for OVCFs. Study Design: A systematic review of overlapping meta-analyses Setting: The electronic databases of PubMed, Embase and The Cochrane Library were searched. The search extended through Sept. 30, 2017. Moreover, we manually searched the last 10 years of conference reports and papers from the Peking University Health Science Library and consulted 2 experts in the field for any additional relevant information. Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Statement and used “A Measurement Tool to Assess Systematic Reviews” (AMTASR) and the Oxford Levels of Evidence to assess the methodological quality of the studies. We applied the Jadad decision algorithm to select the best evidence review. Results: Seven meta-analyses were included in this systematic review. The AMTASR scores of the studies ranged from 4 to 9, with an average of 6. Finally, Sun H et al was shown to represent the best evidence study. Sun H et al proposed that the unilateral kyphoplasty required less surgical time and consumed less cement, reduced cement leakage, and improved short-term general health compared with that of bilateral kyphoplasty. Limitations: The AMTASR scores indicated that some of the included studies were of low quality. In addition, not all of the studies used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) level. When used, the GRADE level indicated that most of the results consisted of studies of low quality. Conclusions: Unilateral kyphoplasty reduces the operative time, cement volume, and cement leakage rate compared with bilateral kyphoplasty. Therefore, we conclude that unilateral kyphoplasty is more advantageous, effective and safe, compared to bilateral kyphoplasty for the treatment of OVCFs. Key words: Osteoporotic vertebral compression fracture, kyphoplasty, unilateral, bilateral, unipedicular, bipedicular, systematic review

Percutaneous Kyphoplasty: Is Bilateral Approach Necessary?

A multicenter retrospective study of patients who underwent unilateral and bilateral balloon kyphoplasty. The aim of this study was to compare the radiographic and clinical results of unilateral and bilateral balloon kyphoplasty to treat osteoporotic vertebral compression fractures. Percutaneous kyphoplasty has long been used as a successful method in the treatment of osteoporotic vertebral compression fractures. Although the bilateral approach is considered to be the mainstay application of percutaneous kyphoplasty, the unilateral approach has also been shown to be sufficient and even more effective in some cases. A total of 87 patients who underwent percutaneous kyphoplasty due to osteoporotic vertebral compression fractures between 2009 and 2016 were retrospectively evaluated and divided into two groups as patients who underwent unilateral or bilateral percutaneous kyphoplasty. Unilateral percutaneous kyphoplasty was performed in 36 and bilateral percutaneous kyphoplasty in 51 patients. The groups were compared in terms of clinical outcomes, radiological findings, and complications. Clinical outcomes were evaluated using Visual Analogue Scale and Oswestry Disability Index and the radiological findings were evaluated by comparing the preoperative and postoperative day 1 and year 1 values of anterior, middle, and posterior vertebral heights and kyphosis angle. Clinical improvement occurred in both groups but no significant difference was observed. In radiological workup, no significant difference was found between the groups in terms of improvements in vertebral heights and kyphosis angle. Operative time and the amount of cement used for the surgery were significantly lower in the patients that underwent unilateral kyphoplasty. Unilateral percutaneous kyphoplasty is as effective as bilateral percutaneous kyphoplasty both radiologically and clinically. Operative time and the amount of cement used for the surgery are significantly lower in unilateral kyphoplasty, which may play a role in decreasing complication rates. 3.

The Role of Unilateral Balloon Kyphoplasty for the Treatment of Patients with OVCFS: A Systematic Review and Meta-Analysis

An increasing number of studies have been conducted to apply unilateral balloon kyphoplasty in the treatment of ostroporotic vertebral compression fractures (OVCFs). However, the efficacy and safety of unilateral kyphoplasty and whether a unilateral or a bilateral approach is superior is controversial. The purpose of this study was to evaluate the role of unilateral balloon kyphoplasty and use meta-analysis to compare the efficacy and safety of unilateral and bilateral kyphoplasty in patients with OVCFs. A systematic literature search was conducted from 1970 to April 2017 using Medline database and the Cochrane Central Register of Controlled Trials. Articles were limited to those published in English. Randomized controlled trials and nonrandomized comparative studies were also included. The following search terms were used: "osteoporotic vertebral compression fractures," or "OVCF," and "unilateral kyphoplasty," or "unipedicular approach," or "single balloon kyphoplasty," or "one balloon kyphoplasty." A comprehensive search of reference lists of retrieved articles and previous published reviews was also performed to ensure inclusion of all possible studies. All potential articles were independently reviewed by 2 investigators for inclusion into the final analysis. MINORS score was used for nonrandomized studies, and Detsky quality index was applied for prospective randomized controlled trials. Systematic review and meta-analysis was performed for the included studies. After unilateral balloon kyphoplasty the mean postoperative visual analog score (VAS) was from 1.74 to 4.77, mean postoperative kyphotic angle was from 5.9º to 11.22º, and complications involving cement leaks was from 6.8 to 21.9% or adjacent level fractures was from 0 to 5.6%). Unilateral kyphoplasty had significantly lower operative time, and less bone cement volume; however, the postoperative VAS, Oswestry Disability Index (ODI), vertebral height restoration rate, and cement leakage and adjacent vertebral fracture rate, were similar to bilateral kyphoplasty. Only 6 randomized controlled trials and 3 retrospective comparative studies were selected for analysis. Heterogeneity was detected among the studies when we pooled the outcomes. Based on the available evidence, the clinical and radiological results of unilateral balloon kyphoplasty were as good as those of bilateral balloon kyphoplasty for the treatment of OVCFs. And unilateral kyphoplasty had advantages in terms of operation time, radiation exposure, and cost. Unilateral balloon kyphoplasty, bilateral balloon kyphoplasty, osteoporotic vertebral compression fractures, complications of balloon kyphoplasty, meta-analysis.

Can Unilateral Kyphoplasty Replace Bilateral Kyphoplasty in Treatment of Osteoporotic Vertebral Compression Fractures? A Systematic Review and Meta-analysis

Background: Kyphoplasty has been proven to be an efficient method to relieve patient suffering from osteoporotic vertebral compression fractures (OVCFs). Because of its technological superiority, unilateral kyphoplasty consumes less operative time and bone cement than traditional bilateral kyphoplasty. However, there is controversy about which method is most efficient in the treatment of OVCFs. Thus, an overall analysis should be performed to shed light on the facts corroborating both procedures. Objective: To evaluate the safety and efficacy of unipedicular kyphoplasty versus bipedicular kyphoplasty in treating OVCFs. Study Design: Inclusion criteria were randomized controlled trials focusing on comparing unilateral versus bilateral balloon kyphoplasty in treatment of OVCFs. The exclusion criteria contained infection, neoplastic etiology, traumatic fracture, neural compression, neurological deficit, spinal stenosis, previous surgery at the involved vertebral body, long-term use of steroids, and kyphoplasty with other invasive or semi-invasive intervention treatment. Retrospective studies, reviews, technology introductions, and biochemical trials were also excluded. Settings: The PubMed MEDLINE, Cochrane Library, Web of Science, and EMBASE were systematic searched. Only randomized controlled trials published up to June 2015 comparing unilateral kyphoplasty with bilateral kyphoplasty in treatment of OVCFs were identified. Methods: Two researchers independently screeded the works for inclusion and data extraction. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system was used to assess the methodological quality and evidence synthesis. Results: Six articles with 563 patients were enrolled in this study. Results showed that the unilateral approach required less surgical time (MD, -23.19; 95% CI, [-27.08, -19.31]; P < 0.00001) and cement consumption (MD, -2.07; 95% CI, [-2.23, -1.91]; P < 0.00001), as well as a reduced cement leakage ratio (RR, 0.59; 95% CI, [0.35, 0.99]; P < 0.05) and improved short-term general health (MD, 1.48; 95% CI, [0.02, 2.93], P < 0.05). No significant difference was found in the visual analog scale score (short-term and long-term), Oswestry Disability Index score (mid-term and long-term) kyphotic angle reduction, restoration rate of anterior vertebral height, vertebral height loss rate, postoperative adjacent-level fractures, or in other assessments of 36-Item Short Form Health Survey parameters (short-term and long-term). Limitations: Only 6 studies were included, so that the sample size was still relatively small and publication bias could not be revealed in this study. Observation time of some data was inconsistent. All of these problems could influence the reliability of the results. Conclusion: Both unilateral kyphoplasty and bilateral kyphoplasty are safe and effective treatments for OVCFs. However, when operative time, cement volume, cement leakage, short-term general health, radiation dose, and hospitalization costs are taken into consideration, unilateral kyphoplasty may be the better choice. Yet, more high-quality RCTs with long-term follow-up are still required to make the final conclusion. Key words: Kyphoplasty, unilateral approach, bilateral approach, osteoporotic vertebral compression fractures, meta-analysis

Safety and efficacy of kyphoplasty in the treatment of tumoral disease of the spine

Vertebral fractures in oncology patients cause significant pain and disability, with decreased quality of life. The aim of the study is to assess the efficacy and safety of kyphoplasty in this type of vertebral fracture in the acute phase. Materials and methodsA retrospective study was conducted on 75 consecutive oncology patients with 122 acute vertebral fractures, who underwent bilateral balloon kyphoplasty, with a mean follow-up of 11 months. ResultsAlmost all (91%) of the patients improved their pain level. The mean improvement in the Visual Analogue Scale (VAS) was 4.28 points (preoperative value 7.49 [SD 1.19], postoperative 3.21 [SD 0.95]). Before surgery, 53% of patients needed major opioids (40 cases), and one month after surgery only 12% (9 patients) required them.Quality of life determined by the Karnofsky index improved from 60.2 (SD 10) to 80.7 (SD 12.1). Cement leaks were found in 5.7% (7 cases), all without neurological repercussions. New fractures appeared in 11 patients. This subgroup showed a slight worsening of the initially acquired clinical improvement. No neurological or pulmonary complications related to surgical technique were found. ConclusionsKyphoplasty is an effective and safe for treating vertebral fractures in patients with cancer. Level of evidenceLevel IV.

Seguridad y eficacia de la cifoplastia en el tratamiento de la enfermedad tumoral de la columna vertebral

Vertebral fractures in oncology patients cause significant pain and disability, with decreased quality of life. The aim of the study is to assess the efficacy and safety of kyphoplasty in this type of vertebral fracture in the acute phase. Materials and methodsA retrospective study was conducted on 75 consecutive oncology patients with 122 acute vertebral fractures, who underwent bilateral balloon kyphoplasty, with a mean follow up of 11 months. ResultsAlmost all (91%) of the patients improved their pain level. The mean improvement in the Visual Analogue Scale (VAS) was 4.28 points (preoperative value 7.49 [SD 1.19], postoperative 3.21 [SD 0.95]). Before surgery, 53% of patients needed major opioids (40 cases), and one month after surgery only 12% (9 patients) required them.Quality of life determined by the Karnofsky index improved from 60.2 (SD 10) to 80.7 (SD 12.1). Cement leaks were found in 5.7% (7 cases), all without neurological repercussions. New fractures appeared in 11 patients. This subgroup showed a slight worsening of the initially acquired clinical improvement. No neurological or pulmonary complications related to surgical technique were found. ConclusionsKyphoplasty is an effective and safe for treating vertebral fractures in patients with cancer. Level of evidenceLevel IV

Unilateral versus bilateral balloon kyphoplasty in the treatment of osteoporotic vertebral compression fractures.

Bilateral and unilateral approaches are the main methods for balloon kyphoplasty. However, controversy exists about which leads to superior outcomes. The goal of this study was to compare the clinical effects and safety of unilateral vs bilateral balloon kyphoplasty for osteoporotic vertebral compression fractures. Five databases (PubMed, Cochrane Library, EMBASE, Web of Science, and Chinese Biomedical Database) were searched without language, publication, or date restrictions. Randomized controlled trials involving a total of 876 patients and comparing the efficacy of unilateral vs bilateral balloon kyphoplasty for osteoporotic vertebral compression fractures were identified. Meta-analysis revealed no significant differences in visual analog scale pain score up to 2-year follow-up (mean difference at 1 week, 0.17 [95% confidence interval (CI), -0.11 to 0.44]; mean difference at 1 year, 0.01 [95% CI, -0.29 to 0.32]; mean difference at 2 years, 0.28 [95% CI, -0.13 to 0.70]), Oswestry Disability Index pain score up to 1-year follow-up (mean difference at 1 week, 1.28 [95% CI, -2.62 to 5.17]; mean difference at 1 year, 1.87 (95% CI, -5.33 to 9.06]), anterior and middle vertebral height (mean difference anterior, -0.13 [95% CI, -0.32 to 0.06]; mean difference middle, -0.16 [95% CI, -0.36 to 0.03]), or kyphotic angle (mean difference, -0.02 [95% CI, -0.65 to 0.61]); however, the unilateral approach resulted in a shorter operative time (mean difference, -19.33 [95% CI, -4.42 to -14.24]), smaller amount of cement injected (mean difference, -2.07 [95% CI, -2.42 to -1.71]), and lower risk of cement leakage (mean difference, 0.47 [95% CI, 0.24-0.92]) than the bilateral approach. The unilateral approach resulted in pain relief and vertebral height and kyphotic angle restoration comparable with that of bilateral kyphoplasty. The unilateral approach should be considered an effective option for the treatment of osteoporotic vertebral compression fractures.

Unilateral Versus Bilateral Balloon Kyphoplasty for Osteoporotic Vertebral Compression Fractures

Background: Osteoporotic vertebral compression fractures (VCFs) commonly occur in aged people. Balloon kyphoplasty (KP) has been proven to be efficacious for pain relief and reduction of vertebral height for patients with osteoporotic VCFs. However, very little is known about the comparison of clinical and radiographic outcomes between unilateral and bilateral balloon KP in treating this kind of patients. Objective: To compare the safety and long-term radiographic and clinical outcomes of unilateral or bilateral balloon KP to treat patients with osteoporotic VCFs. Study Design: A systemic review and meta-analysis of all randomized controlled trials (RCTs) comparing the analgesic efficacy, radiographic outcomes, and complications between unilateral and bilateral balloon KP in patients with osteoporotic VCFs. Setting: The MEDLINE, EMBASE, Pubmed, CINAHL databases, Bandolier, and the Cochrane Controlled Trials Register were systematically searched for evidence from their inception to July 2012 by 2 of the authors (J.L. and L.Z.). Methods: Relevant reports were reviewed by 2 assessors independently and the reference lists of retrieved papers were scrutinized to identify further studies for inclusion, using guidelines set by PRISMA statement criteria. Results: Three RCTs were enrolled in this study. The VAS scores showed no statistical difference between the groups before surgery and either at short-term or long-term follow-up. There was no statistical significance in polymethylmethacrylate (PMMA) leakage between the groups. Analysis of 2 studies showed statistical significance in surgery time (WMD -23.77 [-27.83, -19.71]; P < 0.00001) and PMMA (WMD -1.65 [-2.28, -1.02]; P < 0.00001) consumption between the groups. Limitations: There were few data sources from which to extract abstracted data or published studies. There were only 3 RCTs that met criteria enrollment in this meta-analysis. The quality of these trials was quite low (Jadad score: 1-2). Variable reporting of end points and inconsistent definitions meant that we were not able to include every study for each outcome. There was also clinical heterogeneity among the studies. Conclusion: The efficacy of both unilateral and bilateral balloon KP to provide rapid, significant, and sustained pain relief for patients with osteoporotic VCFs is validated. Unilateral balloon KP is a reasonable treatment for patients with osteoporotic VCFs considering that it could achieve equivalent pain relief with less surgery time and PMMA consumption compared to bilateral balloon KP. There was no evidence to prove that unilateral balloon KP results in higher incidence of PMMA leakage than bilateral balloon KP. Although unilateral balloon KP was less efficacious in the reduction of fractured vertebral body, it is still unclear if the clinical results of balloon KP were positively correlated with the restoration of vertebral height and amount. Key words: Kyphoplasty, unilateral approach, bilateral approach, , postoperative pain, osteoporotic fractures

A Randomized Trial of Balloon Kyphoplasty and Nonsurgical Management for Treating Acute Vertebral Compression Fractures

Multicenter randomized controlled trial. To compare the efficacy and safety of balloon kyphoplasty (BKP) with nonsurgical management (NSM) during 24 months in patients with painful vertebral compression fractures (VCFs). Recently, several large randomized controlled trials have been conducted and reported how vertebral augmentation compares with NSM for patients with acute VCFs. Few of these trials report on the surgical aspects and radiographical vertebral deformity results. Adults with 1 to 3 VCFs were randomized within 3 months of pain to undergo bilateral BKP (n = 149) or NSM (n = 151). Surgical parameters, subjective quality of life assessments and objective functional (timed up and go) and radiographical assessments were collected. Compared with NSM, the BKP group had greater improvements in SF-36 physical component summary (PCS) scores at 1 month (5.35 points; 95% CI, 3.41-7.30; P < 0.0001) and when averaged across the 24 months (overall treatment effect 2.71 points; 95% CI, 1.34-4.09; P = 0.0001). The kyphoplasty group also had greater functionality by assessing timed up and go (overall treatment effect -2.49 s; 95% CI, -0.82 to -4.15; P = 0.0036). At 24 months, the change in index fracture kyphotic angulation was statistically significantly improved in the kyphoplasty group (average 3.13° of correction for kyphoplasty compared with 0.82° in the control, P = 0.003). Number of baseline prevalent fractures (P = 0.0003) and treatment assignment (P = 0.004) are the most predictive variables for PCS improvement; however, in patients who underwent BKP, there may also be a link with kyphotic angulation. In BKP, the highest quart for kyphotic angulation correction had higher PCS improvement (13.4 points) than the quart having lowest correction of angulation (7.40 points, P = 0.0146 for difference). The most common adverse events temporally related to surgery (i.e., within 30 d) were back pain (20 BKP, 11 NSM) new VCF (11 BKP, 7 NSM), nausea/vomiting (12 BKP, 4 NSM), and urinary tract infection (10 BKP, 3 NSM). Several other adverse events were possibly related to patient positioning in the operating room. Compared with NSM, BKP improves patient quality of life and pain averaged during 24 months and results in better improvement of index vertebral body kyphotic angulation. Perioperative complications may be reduced with more care in patient positioning. 2.

Comparison of unilateral versus bilateral balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures

Thirty-one patients with osteoporotic vertebral compression fractures (OVCF) were treated with unilateral balloon kyphoplasty (BKP), and 31 patients were treated with bilateral BKP. The efficacy of unilateral and bilateral BKP was assessed by comparing operation time, X-ray exposure times, incidence of complications, vertebral height restoration, and improvement of the visual analogue scale (VAS) scores. The mean operative time and the exposure time to X-rays in the unilateral BKP group was less than that of the bilateral BKP group (p<0.05). No statistically significant differences were observed in the cement leakage rate, VAS score, or vertebral height restoration between the two groups (p>0.05). Unilateral and bilateral BKP are safe and effective treatments for OVCF. Compared with bilateral BKP, patients undergoing unilateral BKP have shorter operations and receive lower X-ray radiation doses.

Unilateral Versus Bilateral Balloon Kyphoplasty for Multilevel Osteoporotic Vertebral Compression Fractures

A prospective study of patients who underwent multilevel balloon kyphoplasty at a single institute. To examine and compare the safety and long-term radiographic and clinical effects of unilateral or bilateral balloon kyphoplasty to treat multilevel symptomatic vertebral compression fractures. Typically, balloon kyphoplasty involves placement of inflatable bone tamp via a bilateral transpedicular or extrapedicular approach. Recently, several articles reported unilateral kyphoplasty with comparable outcomes. However, few prospective randomized study comparing the radiographic and clinical outcomes using unilateral and bilateral approaches was reported. METHODS.: Forty-nine patients with 114 Osteoporotic vertebral compression fractures were randomly allocated into two groups adopting unilateral or bilateral balloon kyphoplasty. Preoperative and postoperative pain scores, back disability, and 36-Item Short Form Health Survey scores were compared with at least a 2-year follow-up. Vertebral body height and vertebral body kyphotic angle from this cohort were analyzed before surgery, after surgery, and at final follow-up. Both unilateral and bilateral balloon kyphoplasty resulted in significant pain reduction and back dysfunction improvement and remained unchanged at final follow-up. Quality of life assessment using 36-Item Short Form Health Survey recorded marked and significant improvements in all mean subscale scores except general health and social function. Regarding the pain reduction, back dysfunction, and 36-Item Short Form Health Survey scores, no significant difference existed between two groups. Significant increases of anterior and middle vertebral heights were recorded for both groups after surgery and maintained for the period of follow-up. The mean correction of vertebral body kyphotic angle was about 7° in both groups. Asymptomatic cement extravasation occurred in six of 49 of patients, and three patients developed additional fractures at untreated levels during the period of follow-up. Both unilateral and bilateral kyphoplasty markedly improve symptom-related clinical effects of multilevel vertebral compression fractures and result in significant vertebral height restoration and kyphosis correction that remains stable for at least 2 years after treatment.

Minimal Invasive Short Posterior Instrumentation Plus Balloon Kyphoplasty With Calcium Phosphate for Burst and Severe Compression Lumbar Fractures

Prospective consecutive series. To evaluate the efficacy of minimal invasive surgery for acute lumbar fractures by means of balloon kyphoplasty with calcium phosphate plus segmental short posterior instrumented fusion. In the surgical treatment of lumbar fractures with short pedicle screw instrumentation, the failure to support the anterior spinal column often results in loss of correction. Transpedicular augmentation techniques with bone and bone substitutes have been attempted whereas kyphoplasty has been increasingly used to augment fractured vertebral body. Eighteen consecutive patients with an average age of 64 +/- 15 years, who sustained lumbar (L1-L4) burst and severe compression fracture were included in this prospective study. On admission, 2 (11%) of 18 patients had incomplete neurologic impairment. All patients underwent bilateral balloon kyphoplasty with calcium phosphate bone cement to reduce segmental kyphosis and restore vertebral body height and segmental pedicle screw instrumentation and fusion. Gardner kyphosis angle, anterior (AVBHr) and posterior vertebral body height ratio (PVBHr), and spinal canal encroachment (SCE) were calculated before to after surgery. VAS and SF-36 were used to evaluate functional outcome. All patients were operated within 24 hours after admission and were followed for an average 22 months (17-28 months) after index surgery. Operating time and blood loss averaged 45 minutes and 70 mL, respectively. VAS and SF-36 (role physical and bodily pain domains) were significantly improved after surgery. Both patients with incomplete neurologic lesions recovered, whereas no neurologic deterioration was observed in any case. Segmental kyphosis improved from an average preoperative kyphosis of 16 to 2 degrees after surgery (P < 0.000). AVBHr improved from an average before surgery 0.57 to 0.87 (P < 0.000) after surgery, whereas PVBHr improved from 0.93 before surgery to 0.98 (P < 0.05) after surgery. SCE was reduced from an average 25% before surgery to 19% (P < 0.07) after surgery. Bone cement leakage was observed anteriorly to the fractured vertebral body or to the adjacent superior disc in 4 patients without clinical sequelae, whereas 3 pedicle screws were malpositioned medially to the pedicle in 3 patients without neurologic impairment or associated complaints. Posterolateral radiologic fusion was achieved within 6 to 8 months after index operation. There was no instrumentation failure or loss of sagittal curve and vertebral height correction. Balloon kyphoplasty with calcium phosphate cement combined with posterior segmental short minimal invasive fixation for fresh burst and severe compression lumbar fractures provided excellent immediate reduction of post-traumatic segmental kyphosis with simultaneous reduction of spinal canal encroachment and restoration of vertebral body height in the fracture level.

Comparative study of balloon kyphoplasty with unilateral versus bilateral approach in osteoporotic vertebral compression fractures

This study analyses the radiological and clinical results according to the two techniques of unilateral and bilateral balloon kyphoplasty in osteoporotic vertebral compression fractures. Fifty-two patients with osteoporotic vertebral compression fractures occurring at the thoracolumbar junction were enrolled in this study. All patients were classified into two groups; group I was treated with a unilateral approach and group II with a bilateral approach. The Cobb angle was measured each time to evaluate the kyphotic angle during the pre- and post-operative periods and at last follow-up, and a 10-point visual analog scale for pain was recorded at the same time. We found that the bilateral approach had a greater advantage in the reduction of kyphosis and the loss of reduction was less than the unilateral approach for the treatment of osteoporotic vertebral compression fractures.