Comparison of Bilateral and Unilateral Applications of Percutaneous Vertebroplasty and Kyphoplasty Procedures

BACKGROUND Vertebral fractures result from degenerative, osteoporotic, or traumatic spinal loading. Treatment options include conservative management, segmental fusion, and percutaneous vertebroplasty/kyphoplasty (PVP/BKP) performed using unilateral or bilateral pedicular approaches. This study compared vertebral height restoration, pain and disability outcomes, and complication rates between unilateral and bilateral PVP/BKP techniques. MATERIAL AND METHODS This retrospective analysis encompassed 150 patients (99 women, 51 men) who underwent PVP/BKP between January 2021 and January 2024. Patient comorbidities and fracture characteristics, including number and type (crush, biconcave, wedge), were recorded. Preoperative and postoperative computed tomography images were evaluated to measure anterior, middle, and posterior vertebral column heights in the sagittal plane. Pain and functional status were assessed using the visual analog scale (VAS) and Oswestry Disability Index (ODI) preoperatively, on postoperative day 1, and at 1 month postoperatively. RESULTS No significant differences (P>0.05) were observed between unilateral and bilateral groups regarding age, sex distribution, comorbidity rates, fracture number or type, anterior or posterior column height gain, total vertebral height gain, complication rates, or VAS and ODI scores. The bilateral group demonstrated a greater increase in middle column height (P<0.05). Both groups showed significant reductions (P<0.05) in VAS and ODI scores at 1 day and 1 month postoperatively. CONCLUSIONS Unilateral and bilateral PVP/BKP techniques provide significant pain relief and functional improvement with comparable clinical outcomes. Considering factors such as high comorbidity burden, cement-related risks, shorter procedure and anesthesia duration, and lower cost, the unilateral approach may be preferable in selected patients.