Objective:

To 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), focusing on primary outcomes such as operative duration and cement leakage.

Approach:

Key Findings:

• UEA-PKP and BTA-PKP showed comparable efficacy in Oswestry Disability Index score, Visual Analog Scale score, kyphotic correction, and vertebral height restoration. UEA-PKP resulted in shorter operative duration (MD = -8.43, 95% CI: -10.90 to -5.96), reduced radiation exposure (MD = -7.23, 95% CI: -11.31 to -3.15), lower cement volume (MD = -0.94, 95% CI: -1.57 to -0.32), and lower cement leakage rate (OR = 0.49, 95% CI: 0.28–0.85) compared to BTA-PKP.

Interpretation:

UEA-PKP may offer safety advantages while maintaining similar efficacy compared to BTA-PKP, but findings are based on a limited number of studies and should be interpreted as exploratory.

Limitations:

• The analysis is based exclusively on a limited number of retrospective cohort studies, which may limit the robustness of the findings.
• The included studies varied in fracture severities, which may affect the generalizability of the results.

Conclusion:

UEA-PKP may provide safety benefits while achieving similar efficacy to BTA-PKP in treating OVCFs, but further studies are needed to validate these findings.

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