Comparison of unilateral and bilateral robot-assisted percutaneous kyphoplasty in treating Osteoporotic vertebral compression fracture.

Abstract

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

Methodology: Our study retrospectively analyzed 78 patients (unilateral group: 48, bilateral group: 30) with OVCF 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 Analogue Scale scores (VAS), Oswestry Dysfunction Index (ODI), Cobb angle, and vertebral height, bone cement leakage, Adjacent Vertebral Fracture (AVF) and Postoperative 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 in the unilateral group (P <0.05). X-ray exposure dose were no significant differences in the two groups (P>0.05). Bone cement leaked 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. Adjacent Vertebral Fracture 8 cases (16.67%) 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. Still, bilateral RAPKP has better postoperative cement distribution, and we believe that bilateral RAPKP has a better long-term prognosis, so we recommend bilateral RAPKP.