Unilateral versus bilateral percutaneous balloon kyphoplasty for osteoporotic vertebral compression fractures

Abstract

Background:Unilateral and bilateral percutaneous balloon kyphoplasty (PKP) are 2 main approaches for the treatment of patients with osteoporotic vertebral compression fractures (OVCFs). Numerous published systematic reviews and meta-analyses evaluating the effectiveness of 2 approaches remain inconclusive. In order to propose a significant principle to make decisions for comparing clinical safety and efficacy of unilateral versus bilateral PKP for treating OVCFs patients based on the currently best available evidence, a systematic review of overlapping meta-analysis was conducted.Methods:Three electronic databases, Pubmed/Medline, Embase2 and the Cochrance Library, were searched systematically to retrieve and identify all eligible systematic reviews and meta-analyses comparing unilateral and bilateral PKP for the treatment of patients with OVCFs. Only systematic reviews or meta-analyses with an exclusively pooled analysis of randomized controlled trials (RCTs) met the minimum eligibility criteria in this investigation. The Oxford Levels of Evidence, Jadad algorithm and Assessment of Multiple Systematic Reviews (AMSTAR) instrument were adopted for evaluation of the methodological quality for each included literature to select currently best available evidence.Results:Screening determined that out of 2159, 9 meta-analyses with level II or III of evidence met the inclusion criteria in the systematic review of overlapping meta-analyses. The multiple systematic reviews scores ranged from 8 to 9 with a mean of 8.55 (median 8.5). According to the search process and selection strategies of the Jadad algorithm, a meta-analysis by Feng et al with the best available evidence (12 RCTs and an AMSTAR score of 9) demonstrated that unilateral and bilateral PKP are both nice choices for the treatment of patients with OVCFs, and no significant differences were revealed in clinical scores, radiological outcomes, and quality of life with long-term follow-up. However, compared with bilateral PKP, unilateral PKP produced a shorter surgery time, smaller dosage of cement, lower risk of cement leakage, and relieved a higher degree of intractable pain at short-term follow-up after surgery.Conclusion:Unilateral percutaneous balloon kyphoplasty is more advantageous and superior to bilateral percutaneous kyphoplasty, and should be considered an effective option for the treatment of patients with osteoporotic vertebral compression fractures.

Comparison of percutaneous curved kyphoplasty and bilateral percutaneous kyphoplasty in osteoporotic vertebral compression fractures: a randomized controlled trial

“…PKP can reconstruct the vertebral body height, increase the stiffness of vertebral bodies, immediately stabilize the vertebral body, quickly relieve back pain, reduce the complications in bed, improve cardiopulmonary function, improve the quality of life of elderly patients and is currently the preferred treatment of OVCF [ 10 , 11 ].In recent years many scholars have proposed the use of a unilateral pedicle puncture in PKP [ 5 , 6 , 12 , 13 ]. Compared with bilateral PKP, unilateral PKP produced advantages such as a shorter surgery time, smaller dosage of cement, lower risk of cement leakage, and relieved a higher degree of intractable pain at short-term follow-up after surgery [ 14 ]. Indeed, unilateral puncture PKP can reduce both the operation time and complications of bilateral punctures [ 12 ].…”

Could lateral decubitus position improve the cement distribution of unilateral percutaneous kyphoplasty in patients with osteoporotic vertebral compression fracture?

“…Recent comparative studies [14,15] found that unilateral PKP are safe and effective for OVCF patients as bilateral PKP, but need less radiation dose, less operation time and fewer cement volume. And several meta-analyses [16][17][18] proposed the similar viewpoints and suggested that unilateral PKP appeared to be superior to bilateral PKP in the treatment of OVCFs. Hence, unilateral PKP might be recommended to treat OVCF due to these advantages.…”

Comparison of efficacies of unipedicular kyphoplasty and bipedicular kyphoplasty for treatment of single-level osteoporotic vertebral compression fractures

“…The authors also reported that the greater cement leakage in the unipedicular group to the spinal canal was caused by efforts to position the bone tamp more centrally during surgery. However, unipedicular KP is generally known to reduce the risks associated with placing large-bore needles in the spine [ 26 ] ; these risks include pedicle fracture, spinal canal invasion, nerve damage, cement leakage through the cannula tract, and spinal epidural hematoma. In this study, we found no significant differences in the degree of KA recovery between the 2 groups.…”

“…A recent meta-analysis demonstrated that there is no consensus on whether bipedicular KP has similar efficacy to unipedicular KP, [ 20 , 22 , 23 ] or whether unipedicular KP is superior, as it has a shorter procedure time and requires less cement. [ 21 , 24 – 26 ] Therefore, this study aimed to compare the efficacies of bipedicular and unipedicular KP and determine which of the 2 methods is superior.…”