Comparison of unipedicular and bipedicular kyphoplasty for the treatment of osteoporotic vertebral compression fractures in the lower lumbar spine

Abstract

Abstract Background Both unipedicular and bipedicular approaches for percutaneous kyphoplasty are reportedly effective for the treatment of osteoporotic vertebral compression fractures (OVCFs). However, most of the literature has reported on thoracolumbar fractures, with few reports describing the treatment of the lower lumbar spine. This study compared the clinical and radiological results between the unipedicular versus bipedicular approachesfor percutaneous kyphoplasty for the treatment of osteoporotic vertebral compression fractures. Methods We retrospectively reviewed the records of 160 patients who underwent percutaneous kyphoplasty for lower lumbar (L3­–L5) osteoporotic vertebral compression fractures between January 2016 and January 2020. Patient characteristics, surgical outcomes, operation time, blood lose, clinical and radiological features, and complications were compared between the two groups. Cement leakage, height restoration, and cement distribution were calculated from the radiographs. Visual pain analog scale (VAS), the Oswestry disability index (ODI), were calculated before surgery and immediately and 2 years after surgery. Results The results showed significantly improved the visual analog scale (VAS) score, Oswestry Disability Index (ODI) score, and vertebral height restoration in each group (p<0.05), with no significant differences between the two groups (p>0.05). The mean operation time and blood lose in the unipedicular group was less than that in the bipedicular group(p<0.05). Different types of bone cement leakage were observed in both groups. The leakage rate was higher in the bipedicular group than in the unipedicular group. Patients in the bipedicular group showed greater improvement in bone cement distribution compared to that in patients in the unipedicular group (p<0.05). Conclusions Despite the relatively worse cement distribution, unipedicular approach PKP is a safe and minimally invasive surgical method that has the advantages of short operation time, less blood loss and radiation exposure compared to bipedicular approach PKP for OVCFs.