Comparison of unipedicular and bipedicular balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures

Rebolledo, Brian J.; Gladnick, Brian P.; Unnanuntana, Aasis; Nguyen, Joseph; Kepler, Chris K.; Lane, Joseph M.

doi:10.1302/0301-620x.95b3.29819

Cited by 52 publications

(67 citation statements)

References 28 publications

(26 reference statements)

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“…However, both biomechanical data [96–98] and clinical series [99–102] suggest that unipedicular procedure is safe and effective. Comparative studies also claim no difference in clinical or radiological parameters [103–106] with the exception of a retrospective study by Chung and coauthors who found same pain reduction but superior kyphosis restoration with bipedicular approach [107]. Only difference may be the smaller cement amount filling in unilateral operations [103, 104], which may be as low as 0.8 cc as seen from our data.…”

Section: Unipedicular Versus Bipedicular Approachsupporting

confidence: 52%

Controversial Issues in Kyphoplasty and Vertebroplasty in Osteoporotic Vertebral Fractures

Papanastassiou

Filis

Gerochristou

et al. 2014

BioMed Research International

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Kyphoplasty (KP) and vertebroplasty (VP) have been successfully employed for many years for the treatment of osteoporotic vertebral fractures. The purpose of this review is to resolve the controversial issues raised by the two randomized trials that claimed no difference between VP and SHAM procedure. In particular we compare nonsurgical management (NSM) and KP and VP, in terms of clinical parameters (pain, disability, quality of life, and new fractures), cost-effectiveness, radiological variables (kyphosis correction and vertebral height restoration), and VP versus KP for cement extravasation and complications profile. Cement types and optimal filling are analyzed and technological innovations are presented. Finally unipedicular/bipedicular techniques are compared. Conclusion. VP and KP are superior to NSM in clinical and radiological parameters and probably more cost-effective. KP is superior to VP in sagittal balance improvement and cement leaking. Complications are rare but serious adverse events have been described, so caution should be exerted. Unilateral procedures should be pursued whenever feasible. Upcoming randomized trials (CEEP, OSTEO-6, STIC-2, and VERTOS IV) will provide the missing link.

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Section: Unipedicular Versus Bipedicular Approachsupporting

confidence: 52%

Controversial Issues in Kyphoplasty and Vertebroplasty in Osteoporotic Vertebral Fractures

Papanastassiou

Filis

Gerochristou

et al. 2014

BioMed Research International

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“…As for cement dosage, outcomes revealed statistically significant (less cement for unilateral approach; MD = −2.05; 95%CI = −2.19 to −1.91; p < 0.00001) (Fig. ) …”

Section: Resultsmentioning

confidence: 93%

“…As for restoration rate, outcomes revealed no differences between unilateral and bilateral percutaneous kyphoplasty (MD = −0.40; 95%CI = −10.48 to 9.69; p = 0.94; I 2 = 94%, random effect model used) (Fig. ) …”

Section: Resultsmentioning

confidence: 97%

Unilateral versus bilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures: A systematic review and meta‐analysis of RCTs

Feng

Huang

Zheng

et al. 2015

Journal Orthopaedic Research

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The purpose of this research was to compare the efficacy and safety of unilateral versus bilateral PKP for osteoporotic vertebral compression fractures (OVCFs). Six databases (Cochrane, PubMed, MEDLINE, EMBASE, SinoMed, and CNKI) were searched without language restrictions. Twelve randomized controlled trials involving a total of 1,030 patients were identified. The results indicate that unilateral PKP had a better degree of pain relief (visual analog scale) than bilateral PKP (p ¼ 0.04; 95%CI ¼ À0.36 to À0.00) with short-term follow-up (within 4 weeks) after operation. The radiological outcome assessment with short-term follow-up after operation indicates bilateral PKP had a better degree of anterior vertebral height restoration (p ¼ 0.03; 95%CI ¼ À2.58 to À0.14). Operation time and cement dosage were less for unilateral PKP (p < 0.05). There were no differences in complications such as cement leakage and adjacent vertebral fractures between two approaches (p ¼ 0.06 and p ¼ 0.97, respectively). Life quality assessment (SF-36) indicates unilateral PKP had a better result of bodily pain relief (p < 0.05; 95%CI ¼ 3.93 to 7.48) and general health benefit (p < 0.05; 95%CI ¼ 0.02 to 2.93) with short-term follow-up after operation. We suggest that a unilateral PKP is advantageous. ß

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“…3). [11,17,19–27] High heterogeneity ( I 2 = 84.9%) across the studies was observed. The pooled results revealed significant differences in the volume of injected cement (WMD −1.90, 95%CI [−2.26 to −1.54]; P < .001) between the UPKP and BPKP procedures.…”

Section: Resultsmentioning

confidence: 99%

“…5). [9,11,19,21] Heterogeneity across these studies was 85.3%, so a random-effects model was used. Meta-analysis results demonstrated that there were no differences in kyphotic angle reduction (WMD 1.19, 95%CI [−1.38 to 3.76]; P = .365) between the 2 surgical procedures.…”

Section: Resultsmentioning

confidence: 99%

Unilateral versus bilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures

Chang

Zhang²,

Jiao³

et al. 2017

Medicine

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Background:The debate on the efficacy of unilateral percutaneous kyphoplasty (UPKP) and bilateral percutaneous kyphoplasty (BPKP) for the treatment of osteoporotic vertebral compression fractures (OVCFs) is ongoing.This meta-analysis aimed to evaluate the clinical results of UPKP and BPKP in the treatment of OVCFs.Methods:Web of Science, PubMed, Embase, and the Chinese Biomedical Database publication databases were searched using a date range of January 2008 to November 2016, for studies comparing UPKP and BPKP for the treatment of OVCFs. The clinical effectiveness was assessed by comparing perioperative outcomes (surgery time, the volume of injected cement, X-ray exposure time, and kyphotic angle reduction), clinical outcomes (visual analogue scale [VAS] for pain relief and Oswestry Disability Index [ODI] for quality of life), and surgery-related complications (cement leakage and adjacent vertebral fractures). Data were analyzed using Stata/SE11.0 software.Results:Fourteen trials with 1194 patients were retrieved. The pooled results showed significant differences in surgery time (weighted mean difference [WMD] −21.44, 95% confidence interval [CI] [−23.57 to −19.30]; P < .001); volume of injected cement [WMD −1.90, 95% CI [−2.26 to −1.54); P < .001); and X-ray exposure time (WMD −13.66, 95%CI [−19.59 to −7.72]; P < .001) between UPKP and BPKP treatments. However, the pooled results showed no significant differences in kyphotic angle reduction, VAS in the short-term, VAS in the long-term, ODI, cement leakage, or adjacent vertebral fractures between the 2 surgical procedures. Following a subgroup analysis, the results based on randomized controlled trials (RCTs) indicated that there were significant differences in surgery time (WMD −24.65, 95%CI [−26.53 to −22.77]; P < .001) and the volume of injected cement (WMD −1.66, 95%CI [−1.97 to −1.36]; P < .001) between UPKP and BPKP treatment procedures, respectively. The results based on RCTs indicated that there were no significant differences, either in kyphotic angle reduction or in X-ray exposure time, between the 2 surgical procedures.Conclusions:Compared to BPKP procedures, UPKP procedures may achieve similar clinical results in the treatment of OVCFs when assessed in terms of the pain relief, improvements in life quality, and surgery-related complications. However, UPKP procedures had a shorter operation time and volume of injected cement compared with BPKP procedures. Additional high quality and multicenter RCTs are needed to provide further robust evidence.

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Comparison of unipedicular and bipedicular balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures

Cited by 52 publications

References 28 publications

Controversial Issues in Kyphoplasty and Vertebroplasty in Osteoporotic Vertebral Fractures

Controversial Issues in Kyphoplasty and Vertebroplasty in Osteoporotic Vertebral Fractures

Unilateral versus bilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures: A systematic review and meta‐analysis of RCTs

Unilateral versus bilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures

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