Aduri Tharun Teja, Dhillon Mehar, Bansal Parth, Vatkar Arvind, Dhatt Sarvdeep Singh, Kumar Vishal
Department of Orthopaedics, PGIMER, Chandigarh, India.
Consultant orthopaedic spine surgeon, Fortis Hiranandani Hospital and Apollo Hospital, Navi Mumbai, India.
J Clin Orthop Trauma. 2025 Apr 16;66:103010. doi: 10.1016/j.jcot.2025.103010. eCollection 2025 Jul.
Vertebroplasty or kyphoplasty is a safe and effective procedure to treat persistent pain and correct deformity for early mobilisation in an osteoporotic vertebral compression fracture. However, there is conflicting evidence supporting the unipedicular or bipedicular approach in terms of the outcomes and complications with a recent increase in literature and no meta-analysis in this decade. This review is aimed at providing insight into the comparison between unipedicular and bipedicular approaches for making clinical decisions.
Multiple databases were screened using the keywords: "kyphoplasty", "vertebroplasty", "unipedicular", "bipedicular", "osteoporotic fracture", and "compression fracture", and all the results were reviewed for inclusion of 20 articles and data analysis done to look for significant differences between the two approaches. The quality of the studies included is evaluated using MINORS criteria. This review is registered in the International Prospective Register of Systematic Reviews (PROSPERO) with ID: CRD4202511004028.
We found no significant difference between the two groups in terms of patient-related outcomes (Visual Analogue scale and Oswestry Disability Index), radiological outcomes (kyphotic angle correction or vertebral height restoration), complications (cement leakage or adjacent vertebral fractures), fluoroscopy frequency with significantly less operative time in the unipedicular group.
Vertebroplasty and kyphoplasty, irrespective of unipedicular or bipedicular approach, are effective procedures providing pain relief and adequate functional outcomes with comparable complications, with the unilateral approach taking less operative time. However, in a clinical setting, the approach of kyphoplasty or vertebroplasty should depend on a patient's condition, fracture type and symmetry, along with the levels affected.
椎体成形术或后凸成形术是治疗骨质疏松性椎体压缩骨折中持续性疼痛和矫正畸形以实现早期活动的一种安全有效的手术。然而，关于单节段或双节段入路在疗效和并发症方面的证据存在冲突，近期文献有所增加，但近十年尚无荟萃分析。本综述旨在深入比较单节段和双节段入路，以辅助临床决策。
使用关键词“后凸成形术”“椎体成形术”“单节段”“双节段”“骨质疏松性骨折”和“压缩骨折”对多个数据库进行筛选，对所有结果进行审查以纳入20篇文章，并进行数据分析以寻找两种入路之间的显著差异。使用MINORS标准评估纳入研究的质量。本综述已在国际系统评价前瞻性注册库（PROSPERO）注册，注册号为：CRD4202511004028。
我们发现两组在患者相关结局（视觉模拟评分和Oswestry功能障碍指数）、影像学结局（后凸角矫正或椎体高度恢复）、并发症（骨水泥渗漏或相邻椎体骨折）、透视频率方面无显著差异，单节段组手术时间明显更短。
椎体成形术和后凸成形术，无论采用单节段还是双节段入路，都是有效的手术方法，能缓解疼痛并提供相当的功能结局，并发症相似，单侧入路手术时间更短。然而，在临床环境中，后凸成形术或椎体成形术的入路应取决于患者的病情、骨折类型和对称性以及受累节段。
