Background: Studies have found that unilateral and bilateral kyphoplasty have comparable clinical outcomes. Only a few studies have compared the radiographic results of using unilateral vs. simultaneous bilateral approaches. We aimed to examine and compare the radiographic results of unilateral (UKP) vs. bilateral simultaneous double-balloon kyphoplasty (DKP) for treating symptomatic vertebral compression fractures (VCF).

Methods: A retrospective cohort of all patients treated for VCF by DKP and UKP over five years in a single medical center. From 2009 to 2012, we routinely performed UKP; from 2012, DKP was the routine due to potential benefits in vertebral realignment. We evaluated pre- and post-surgical fracture characteristics including vertebral height, sagittal and coronal Cobb angle, and fracture reduction. Statistical analysis included a t-test for independent variables and Pearson’s correlation.

Results: The study cohort consisted of 81 patients (75.8 years ± 10.86) who underwent surgery, with a total of 119 vertebras. We performed 89 UKP on fractured vertebras and 30 DKP on 30 vertebrae. The UKP average fluoroscopy radiation exposure was 15.8 mGy (±11.5) per level compared to 11.2 mGy (±8.7) for DKP, p = 0.03. DKP showed significant fracture reduction, 2.8 degrees of Cobb angle, equaling the patient positioning effect on fracture reduction.

DKP results in better fracture reduction than UKP, and equals the effect of patient positioning without increased radiation exposure or adverse events.