Percutaneous Kyphoplasty: Is Bilateral Approach Necessary?

Atilla Yılmaz, MD; Mürteza Çakır, MD; Cem Şeyho Yücetaş, MD; Boran Urfalı, MD; Necati Üçler, MD; Murat Altaş, MD; Mustafa Aras, MD; Yurdal Serarslan, MD; Rahmi Kemal Koç, MD


Spine. 2018;43(14):977-983. 

In This Article

Abstract and Introduction


Study Design. A multicenter retrospective study of patients who underwent unilateral and bilateral balloon kyphoplasty.

Objective. 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.

Summary of Background Data. 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.

Methods. 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.

Results. 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.

Conclusion. 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.


Osteoporotic vertebral compression fracture (OVCF) is a common entity in elderly patients, with an estimated 1.4 million new fractures occurring every year worldwide.[1–6] OVCFs are mostly missed during diagnosis because back pain is the common symptom presented by elderly patients and there is no history of trauma.[1–6] Patients with OVCFs mostly avoid mobilization to avoid provoking the pain, which leads to a number of complications such as loss of muscle strength, social isolation, reduced pulmonary vital capacity, and upper respiratory tract infections. In addition, prolonged periods of bed rest may lead to increased bone demineralization, thereby leading to additional fractures. Previous studies have shown that even a single osteoporotic vertebral fracture may precipitate additional fractures by altering spinal biodynamics.[7,8] Because of these features, OVCFs lead to significantly increased morbidity and mortality rates for elderly patients.[9–11]

Percutaneous kyphoplasty (PK) is a surgical method that has been used for the treatment of OVCFs since 1998.[12–15] PK has been shown to provide numerous advantages, including restoration of vertebral height and kyphotic angulation (KA) of the spine, quick pain alleviation, early mobilization of the patient, and significantly decreased morbidity.[15–18]

Although bilateral PK (BPK) is considered the mainstay approach and has been shown to be relatively safe and effective,[13,19,20] unilateral PK (UPK) has also been reported to provide numerous benefits such as shorter operative times, less radiation exposure, and lower complication rates.[21–23] Nevertheless, there is still no consensus regarding which method is superior. In this study, we aimed to contribute to the literature by comparing the efficacy of BPK with that of UPK.