Comparison of Unilateral and Bilateral Robot-Assisted Percutaneous Kyphoplasty in Treating Osteoporotic Vertebral Compression Fracture.

OBJECTIVE

To investigate the efficacy and safety of unilateral and bilateral robot-assisted percutaneous kyphoplasty (RAPKP) in treating thoracolumbar osteoporotic vertebral compression fractures.

METHODS

Our study retrospectively analyzed 78 patients (unilateral group: 48, bilateral group: 30) with osteoporotic vertebral compression fracture treated with RAPKP from January 2020 to July 2022. The operation time, X-ray exposure time, bone cement volume, postoperative bone cement distribution, preoperative and postoperative pain visual analog scale (VAS) scores, Oswestry Dysfunction Index (ODI), Cobb angle, vertebral height, bone cement leakage, adjacent vertebral fracture, and postoperative computed tomography (CT) in both groups were recorded.

RESULTS

All patients were successfully treated with RAPKP and followed up for 19.90 ± 5.38 months. Our results showed that the VAS core, ODI, vertebral height, and Cobb angle at postoperative follow-up were significantly improved in both groups compared to the preoperative period (P < 0.05). The operation time in the bilateral group (46.20 ± 6.89 minutes) was not statistically different from the unilateral group (42.54 ± 10.16 minutes) (P > 0.05), while the volume of bone cement injected was significantly more in the bilateral group (5.93 ± 1.81 mL) than in the unilateral group (4.73 ± 0.51 mL) (P < 0.05). In addition, the distribution of bone cement in the bilateral group was significantly better than that in the unilateral group (P < 0.05). There were no significant differences in X-ray exposure dose between the 2 groups (P > 0.05). Bone cement leaked in 9 cases (18.75%) in the unilateral group and 6 cases (20.00%) in the bilateral group (P > 0.05). No neurovascular injury or infection occurred. There were 8 cases (16.67%) of adjacent vertebral fracture in the unilateral group and 4 cases (13.33%) in the bilateral group (P > 0.05). Postoperative CT ratios of adjacent vertebrae (operated vertebra/upper adjacent vertebra: unilateral: 10.65 ± 2.7, bilateral: 11.32 ± 3.1; operated vertebra/lower adjacent vertebra: unilateral: 11.67 ± 3.0, bilateral: 12.48 ± 2.9) (P > 0.05).

CONCLUSIONS

Unilateral or bilateral RAPKP improves patients' VAS, ODI, sagittal index, and Cobb angle. Unilateral RAPKP possesses the advantage of fewer puncture injuries. However, bilateral RAPKP has better postoperative cement distribution, and we believe that bilateral RAPKP has a better long-term prognosis, so we recommend bilateral RAPKP.