J Korean Soc Spine Surg.  2007 Sep;14(3):158-163. 10.4184/jkss.2007.14.3.158.

Comparison of Unipedicular versus Bipedicular Kyphoplasty for Osteoporotic Vertebral Compression Fractures

• Jun DS
• Shin WJ
• Yang SH

• KMID: 1941647
• DOI: http://doi.org/10.4184/jkss.2007.14.3.158

Abstract

STUDY DESIGN: A retrospective study
OBJECTIVES
To compare the radiological and clinical results of the unipedicular and bipedicular approach of kyphoplasty for osteoporotic vertebral compression fractures. SUMMARY OF LITERATURE REVIEW: A unipedicular rather than a bipedicular technique has been suggested to decrease the risks associated with surgical procedures.
MATERIALS AND METHODS
Between July 2005 and May 2006, 136 vertebrae of 97 patients, who underwent kyphoplasty for osteoporotic vertebral compression fractures, were analyzed. Group 1, with the bipedicular approach, consisted of 86 vertebrae of 67 patients with a mean age of 72.2 years. Group 2, with unipedicular approach, consisted of 50 vertebrae of 30 patients with mean age of 73.4 years. The plain radiographs, MRI and surgical records were reviewed.
RESULTS
The mean operation time of the single vertebral body in group 2 was statistically lower than in group 1(p<0.05). There was more disruption of the medial wall of the pedicle in group 2 than in group 1(p<0.05). In the aspect of the volume of cement injected in the thoraco-lumbar junctional vertebrae, group 2 used significantly less cement than group 1(p<0.05). There were no significant differences in the cement leakage, vertebral height restoration, kyphotic deformity correction, admission time and VAS scores between groups 1 and 2(p>0.05).
CONCLUSION
There were no significant differences in clinical satisfaction and radiological results between the unipedicular and bipedicular kyphoplasty. The advantage of a unipedicular approach is the shorter procedure time than the bipedicular approach. This is particularly useful in multi-level compression fractures. The rate of the unipedicular approach in upper and mid thoracic spine is higher because of the higher convergence of the pedicle and the lower volume of vertebral body despite the disadvantages of instrument insertion through the medial pedicle wall.

Keyword

Osteoporosis; vertebral compression fracture; Kyphoplasty; Unipedicular; Bipedicular

MeSH Terms

Congenital Abnormalities
Fractures, Compression*
Humans
Kyphoplasty*
Magnetic Resonance Imaging
Osteoporosis
Retrospective Studies
Spine

Figure

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  Fig. 1. Preoperative CT scans. The solid arrow presented planned trajectory, the dotted arrow presented pedicle convergence. (A) T10, (B) T11, (C) T12.

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  Fig. 2. Postoperative CT scans. (A) T10, (B) T11, (C) T12.

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  Fig. 3. The diagraph shows the VAS scores in group 1 and group 2 at preoperative, postoperative 24 hours and postoperative 3 months. There was no significant difference in VAS scores between group 1 and group 2(p>0.05).

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  Fig. 4. Postoperative CT scans. The arrow presented instrument insertion through medial pedicle wall and cement leakage.

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