Unipedicular vs. Bipedicular Balloon Kyphoplasty in the Treatment of Osteoporotic Vertebral Compression Fractures: Single-Institute 3-Year Follow-Up Results

<i>Background and Objectives:</i> Balloon kyphoplasty is one of the most commonly performed minimally invasive surgical procedures for the treatment of osteoporotic vertebral fractures, with the bipedicular technique being the conventional approach. However, the use of both pedicles may present certain disadvantages, including higher costs, longer operative times, increased radiation exposure, and a greater risk of bone cement leakage. This study aims to report the 3-year follow-up outcomes of double-pedicle and single-pedicle kyphoplasty performed at our institution. <i>Materials and Methods:</i> Between June 2016 and May 2019, a total of 136 patients who presented to our clinic with osteoporotic vertebral fractures and underwent balloon kyphoplasty were included in this retrospective study. Pain relief and quality of life indices were assessed preoperatively and postoperatively. During follow-up examinations, radiographs, VAS (Visual Analog Scale) scores, and ODI (Oswestry Disability Index) scores were evaluated. Radiation exposure was assessed using fluoroscopy time and dose area product (DAP) values. Additionally, total injected cement volume, operative time, and procedural complications were retrieved from patient records. <i>Results:</i> The procedure was successful in all patients. The mean bone cement volume used was 3.4 ± 1.4 mL in the unipedicular group and 5.3 ± 2.1 mL in the bipedicular group. Fluoroscopy time and DAP values were significantly higher in the bipedicular technique compared to the unipedicular technique. At the final follow-up, the average kyphosis correction and mean vertebral height correction ratio were greater in the bipedicular group. The mean reduction in VAS and ODI scores was superior in the bipedicular group at the 1-, 2-, and 6-month follow-ups. However, at the 1-, 2-, and 3-year follow-ups, there was no significant difference in VAS and ODI scores between the two groups. <i>Conclusions:</i> The unipedicular balloon kyphoplasty technique offers several advantages, including shorter operative time, lower cement leakage risk, reduced radiation exposure, and comparable pain score reductions at 1- to 3-year follow-ups. However, the bipedicular technique provides superior short-term pain relief and demonstrates better sagittal alignment correction in long-term follow-ups compared to the unipedicular approach.