Comparative Analysis of Unilateral Extrapedicular and Bilateral Transpedicular Approaches in Percutaneous Kyphoplasty for Osteoporotic Vertebral Compression Fractures

Overview

This systematic review and meta-analysis compare the safety and efficacy of unilateral extrapedicular approach (UEA) versus bilateral transpedicular approach (BTA) in percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fractures (OVCFs). Findings suggest that UEA-PKP offers similar efficacy to BTA-PKP while demonstrating advantages in operative duration, radiation exposure, cement volume, and cement leakage rates.

Background

Osteoporotic vertebral compression fractures (OVCFs) are a significant health concern, particularly among the aging population, leading to pain and reduced quality of life. Percutaneous kyphoplasty (PKP) is a minimally invasive treatment option that aims to restore vertebral height and alleviate pain. The choice between unilateral and bilateral approaches in PKP is critical, as it impacts the distribution of cement and overall treatment outcomes.

Data Highlights

Key Findings

• UEA-PKP shows comparable efficacy to BTA-PKP in Oswestry Disability Index and Visual Analog Scale scores.
• UEA-PKP results in a significantly shorter operative duration compared to BTA-PKP.
• Patients undergoing UEA-PKP experience reduced radiation exposure during the procedure.
• Lower cement volume is required in UEA-PKP compared to BTA-PKP.
• UEA-PKP is associated with a lower rate of cement leakage than BTA-PKP.

Clinical Implications

The findings suggest that UEA-PKP may be a preferable option for patients with OVCFs due to its safety advantages and similar efficacy compared to BTA-PKP. Clinicians should consider UEA for patients requiring percutaneous kyphoplasty, particularly those at risk for complications associated with higher cement volumes and longer operative times.

Conclusion

UEA-PKP may provide a safer alternative to BTA-PKP while maintaining similar clinical outcomes for patients with osteoporotic vertebral compression fractures. Further studies are warranted to confirm these findings.

Related Resources & Content

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2. Springer, 2023 -- Does achieving vertebral body height restoration following fractures and minimally-invasive dorsal stabilization with polyaxial pedicle screws represent a mere illusion?
3. Springer, 2023 -- Comparison of Extramedullary and Intramedullary Fixation Techniques for Unstable Trochanteric Femoral Fractures (AO Type 31-A2): A Systematic Review and Meta-Analysis
4. Huazhong University of Science and Technology, Frontiers in Surgery, 2026 -- Anterior Vertebrectomy and O-Arm Navigation for Old L5 Traumatic Fractures with Kyphotic Deformity: A Retrospective Case Series of Clinical and Radiological Outcomes
5. North American Spine Society, 2024 -- Osteoporotic Vertebral Fracture Appropriate Use Criteria
6. PMC, 2025 -- The effectiveness of balloon kyphoplasty compared to conservative treatment for osteoporotic vertebral compression fractures: A systematic review and meta-analysis
7. PMC, 2025 -- Unilateral extrapedicular versus unilateral and bilateral transpedicular approaches in percutaneous vertebral augmentation for osteoporotic vertebral compression fractures: A meta-analysis
8. Osteoporotic Vertebral Fracture Appropriate Use Criteria
9. The effectiveness of balloon kyphoplasty compared to conservative treatment for osteoporotic vertebral compression fractures: A systematic review and meta-analysis - PMC
10. Unilateral extrapedicular versus unilateral and bilateral transpedicular approaches in percutaneous vertebral augmentation for osteoporotic vertebral compression fractures: A meta-analysis - PMC