Comparison of Unilateral and Bilateral Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures:...

Introduction Osteoporotic vertebral compression fractures (OVCFs) are a common and debilitating consequence of osteoporosis, frequently resulting in severe back pain, spinal deformity, and functional limitation. Percutaneous vertebroplasty (PVP) is widely used for rapid pain relief and vertebral stabilization. However, the debate persists regarding the optimal surgical approach, unilateral versus bilateral. The study aimed to compare the clinical outcomes, radiological parameters, procedural efficiency, and safety profiles of unilateral and bilateral percutaneous vertebroplasty in patients with osteoporotic vertebral compression fractures. Materials and methods This prospective observational comparative study included 40 patients with symptomatic OVCFs, with 20 patients undergoing unilateral PVP and 20 undergoing bilateral PVP based on the operating surgeon's clinical judgment and institutional practice rather than random allocation. Baseline demographic and clinical characteristics were compared between groups. Outcome measures included operative duration, cement volume, fluoroscopy time, visual analog scale (VAS) scores at multiple follow-up intervals, vertebral height restoration, kyphotic angle correction, and complications. Results The unilateral PVP group demonstrated significantly shorter operative time (40.00±2.99 vs 53.65±3.39 minutes), lower cement volume (4.03±0.50 vs 5.03±0.64 mL), and reduced fluoroscopy time (48.10±5.68 vs 70.30±5.68 seconds) compared to the bilateral group (p<0.001 for all). Both groups showed a substantial reduction in VAS scores from a severe baseline (8.00±0.80) to minimal pain at 6 months, with bilateral PVP providing better pain relief at 24 hours (2.40±0.50 vs 3.05±0.83; p=0.005), but no significant differences at later follow-up. Postoperative vertebral height restoration and kyphotic angle correction were comparable between groups (p>0.05). Cement leakage was observed in one (5.0%) patient in the bilateral group and 0 (0.0%) in the unilateral group, with no neurological complications reported. Conclusion Unilateral and bilateral PVP provide equivalent long-term clinical and radiological outcomes in OVCFs. The unilateral approach offers improved procedural efficiency without compromising safety or effectiveness.