Comparative Study of Kyphoplasty for Chronic Painful Osteoporotic Vertebral Compression Fractures via Unipedicular Versus Bipedicular Approach

Study Design: A comparative study of chronic painful osteoporotic vertebral compression fractures (OVCFs), which underwent kyphoplasty via unipedicular versus bipedicular approach. Objective: To assess the clinical and radiographical outcomes in treating chronic painful OVCFs compared by unipedicular and bipedicular kyphoplasty (KP). Summary of Background Data: OVCFs commonly occur in aged people and as many as one-third of them progress to chronic pain. Our previous research has proved that unipedicular and bipedicular KP can achieve comparable radiographical and clinical results in early stage. To give a medium-term and long-term assessment, we completed the comparison of outcomes 6 months and 2 years after surgery. Methods: Fifty patients with a total of 56 chronic painful OVCFs completed the follow-ups of 2 weeks, 6 months, and 2 years after surgery. Group I (n = 27) were treated with unipedicular KP and group II (n = 23) with bipedicular KP. Preoperative and postoperative visual analog scale and Oswestry disability index scores were compared within each group and between groups. The radiographic outcomes were evaluated by the restoration rate and vertebral height lost rate in the most compressed point of the vertebral bodies. Results: Significant improvement on the visual analog scale and Oswestry disability index scores were noted in each group (P < 0.001), and there was no significant difference between the 2 groups. Although the restoration rate in group II was higher than in group I (P = 0.005) in early stage, the height lost ratio showed no significant differences 6 months or 2 years later (P = 0.746, 0.627). Conclusions: Chronic painful OVCFs should be candidates for KP, and there was no difference in pain relief when treated with either unipedicular or bipedicular KP. Although the bipedicular KP is more efficacious in vertebral height restoration in early stage, the unipedicular KP can maintain the same degree of the restored vertebral height in the long run.