Background: 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.
Objectives: 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.
Study Design: 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.
Setting: 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.
Methods: 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.
Results: 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.
Limitations: 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.
Conclusions: 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.
Key words: Unilateral balloon kyphoplasty, bilateral balloon kyphoplasty, osteoporotic vertebral
compression fractures, complications of balloon kyphoplasty, meta-analysis