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Percutaneous Kyphoplasty

Is Bilateral Approach Necessary?

Yilmaz, Atilla, MD; Çakir, Mürteza, MD; Yücetaş, Cem Şeyho, MD; Urfali, Boran, MD; Üçler, Necati, MD; Altaş, Murat, MD§; Aras, Mustafa, MD; Serarslan, Yurdal, MD; Koç, Rahmi Kemal, MD

doi: 10.1097/BRS.0000000000002531

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.

Level of Evidence: 3

Neurosurgery Department, Mustafa Kemal University, Hatay, Turkey

Neurosurgery Department, Ataturk University, Erzurum, Turkey

Neurosurgery Department, Adiyaman University, Adiyaman, Turkey

§Neurosurgery Department, Akdeniz University, Antalya, Turkey

Neurosurgery Department, Erciyes University, Kayseri, Turkey.

Address correspondence and reprint requests to Atilla Yilmaz, MD, Neurosurgery Department, Mustafa Kemal University, Hatay 31070, Turkey; E-mail:

Received 6 September, 2017

Revised 3 November, 2017

Accepted 9 November, 2017

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

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