Background: Several meta-analyses have been performed to compare unilateral percutaneous
kyphoplasty (PKP) and bilateral PKP in the treatment of osteoporotic vertebral compression
fractures (OVCFs), but inconsistencies in the results have led to questions as to which technique
is preferable.
Objective: This study was designed to clarify the benefits and disadvantages of unilateral PKP
versus bilateral PKP as found in numerous discordant meta-analyses and thereby present surgical
treatment recommendations for OVCFs considering the current best evidence.
Study Design: Systematic review/Meta-analysis.
Methods: Meta-analyses on unilateral and bilateral PKP for OVCFs were included by searching
Pubmed, Embase, and Cochrane library. Meta-analysis quality was assessed using Oxford Levels of
Evidence and Assessment of Multiple Systematic Reviews (AMSTAR). The Jadad decision algorithm
was used to identify the best evidence.
Results: Eight eligible meta-analyses were included, 7 of which were Level-II evidence and one was
Level-III evidence. The AMSTAR scores varied from 7 to 8. The Jadad decision algorithm suggested
that the best meta-analysis should be selected depending upon publication characteristics and
methodology of primary studies, language restrictions, and whether data analysis was performed
on individual patients. The best available evidence indicated that both unilateral and bilateral PKP
could receive similar good clinical and radiological outcomes. However, without increasing the risk
of complications, unilateral PKP required shorter surgical time and less cement volume, offering
better pain relief and quality of life at post-operative short term follow-ups.
Limitations: Primary studies had defects in their methodologies.
Conclusions: Unilateral PKP appears to be superior to bilateral PKP in the treatment of OVCFs.
Key words: Osteoporotic vertebral compression fractures, percutaneous kyphoplasty,
meta-analysis
Is Unilateral Percutaneous Kyphoplasty Superior
to Bilateral Percutaneous Kyphoplasty for
Osteoporotic Vertebral Compression Fractures?
Evidence from a Systematic Review of Discordant
Meta-Analyses
