Abstract

Background: Unilateral percutaneous balloon kyphoplasty (PBK) is increasingly utilized for the management of osteoporotic vertebral compression fractures (OVCFs). Its potential advantages include procedural simplicity, reduced tissue trauma, and minimal radiation exposure.

Case Description: A 59-year-old female with osteoporosis presented with back pain but was neurologically intact 2 weeks after a fall. The magnetic resonance imaging documented a thoracic 12 vertebral compression fracture that was successfully treated with a unilateral PBK.

Conclusion: Unilateral PBK appears promising for managing OVCFs in the aging population and offers rapid pain relief, vertebral height restoration, and functional improvement.

Keywords: Age-related osteoporosis, Kyphoplasty, Neurosurgical procedures, Vertebral column

INTRODUCTION

Percutaneous balloon kyphoplasty (PBK) has emerged as a safe and effective minimally invasive procedure for addressing osteoporotic vertebral compression fractures (OVCFs).[ 1 , 2 ] Here, we successfully treated a 59-year-old female with a thoracic (Th) 12 vertebral compression fracture utilizing a unilateral PBK approach. We then chose to explore further whether unilateral approaches, in general, would offer the following advantages over bilateral procedures: greater simplicity, reduced tissue trauma, and less radiation exposure.[ 3 , 4 , 8 ]

CASE DESCRIPTION

A 59-year-old female with osteoporosis presented 2 weeks following a fall with back pain but without a neurological deficit. The pain on the Visual Analog Scale (VAS) was 8/10, and the Oswestry Disability Index (ODI) score was 40%. The thoracic magnetic resonance imaging revealed a Th12 OVCF [ Figure 1 ]. The bone mineral density examination confirmed a low osteoporotic bone (i.e., T-score of −3.0).

Figure 1:

MRI images showing a vertebral compression fracture at thoracic 12 (black arrow) in sagittal (left) and axial (right) views. MRI: Magnetic resonance imaging.

Operative procedure

Under general anesthesia, a unilateral PBK was performed with the patient prone [ Figure 2a ]. An inflatable balloon was positioned in the center of the fractured vertebral body and gradually inflated to a pressure of 150 psi, which successfully reduced the patient’s kyphotic angle [ Figures 2b and c]. Next, 4 cc of cement was injected. After deflation and removal of the balloon, the residual intravertebral cavity was filled with polymethyl methacrylate (PMMA) cement [ Figure 2d and e ].

Figure 2:

Intraoperative procedure. (a) Trocar insertion site is located approximately 4 cm to the right of the midline. (b and c) Balloon inflation to approximately 4 cc, as shown in the C-arm images in (b) anteroposterior (AP) and (c) lateral views. (d and e) C-Arm images (d) immediately and (e) after PMMA injection.

Follow-up and outcome

Postoperatively, back pain significantly improved, i.e., the VAS score improved to 2/10. X-rays showed restoration of both the vertebral height and alignment [ Figure 3 ]. The patient was discharged 2 days later with improved mobility. Activities of daily living markedly improved within the 1^st postoperative week (i.e., ODI score of approximately 5%). No perioperative complications occurred. Six months later, the patient had no residual back pain or neurological deficits.

Figure 3:

Postoperative thoracolumbar X-ray in AP (left) and lateral (right) views showing polymethyl methacrylate within the thoracic 12 vertebrae.

DISCUSSION

The primary goals of PBK surgery for OVCF patients are to reduce back pain, restore vertebral height/alignment, and improve patient mobilization. Although several meta-analyses have documented significant short-term improvement in VAS scores for unilateral versus bilateral PBK, no significant differences were found for long-term follow-ups.[ 1 - 3 , 5 - 11 ] Other studies also demonstrated no significant differences between unilateral vs. bilateral PBK in frequencies and extent of postoperative radiological outcomes, postoperative kyphosis angle reduction, Cobb’s angle improvement, vertebral height reduction, and short- and/or long-term restoration of anterior/middle vertebral heights [ Table 1 ].[ 5 ] However, Feng et al. did demonstrate shorter surgery times and lower PMMA doses used for the unilateral versus bilateral PBK groups; the lower volume of PMMA likely reduced the incidence of symptomatic intra- and postprocedural cement leakage (i.e., higher for bilateral vs. unilateral PBK, which can result in new neurological deficits, cement emboli, etc.).[ 5 ] Our original hypothesis was that for patients with OVCF, unilateral PBK would offer greater simplicity, reduced tissue trauma, and less radiation exposure compared to those undergoing bilateral PBK.[ 9 ] We did confirm these original hypothetical findings while also documenting significant postprocedural improvement in VAS score (i.e., preoperative score 8/10 significantly reduced to 2/10) using the unilateral PBK.

Table 1:

Summary of bilateral vs. unilateral percutaneous kyphoplasty.

CONCLUSION

Unilateral PBK is a promising technique for treating OVCFs. Potential benefits include more pain relief, better functional improvement, and reduced surgical complexity versus routine bilateral approaches.

Ethical approval

Institutional Review Board approval is not required.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Use of artificial intelligence (AI)-assisted technology for manuscript preparation

The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.

Disclaimer

The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.

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