Abstract: BACKGROUND: Osteoporotic vertebral compression fracture is the most common complication of osteoporosis. Percutaneous kyphoplasty is an effective treatment for osteoporotic vertebral compression fractures. Its operative approaches include unilateral and bilateral pedicle approaches. The two approaches have their advantages and disadvantages.  
OBJECTIVE: To explore the clinical effect and value of the unipedicular and bipedicular approaches to percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fracture.
METHODS: 383 patients with osteoporotic vertebral compression fractures of the thoracic and lumbar spine were operated on from March 2014 to April 2020 via bipedicular approach (bipedicular group, 208 cases) and unipedicular approach (unipedicular group, 175 cases) percutaneous kyphoplasty. All patients were followed-up using the Oswestry dysfunction index, visual analog scale score and X-ray inspection preoperatively and postoperatively. The operation time, blood loss, amount of bone cement injected, frequency of X-ray exposure, Cobb angle of vertebral kyphosis, vertebral body leading edge height, intermediate height, cement leakage rate, and incidence of adjacent vertebral body re-fracture were measured and compared between the two groups.  
RESULTS AND CONCLUSION: All patients were followed up for 25-98 months (averaged 43.3 months). (1) Operation time, intraoperative blood loss, amount of bone cement injected, and intraoperative frequency of X-ray exposure were all significantly shorter in the unipedicular group than that in the bipedicular group (P < 0.05). (2) Visual analog scale score, Oswestry dysfunction index, Cobb angle of vertebral kyphosis, vertebral leading edge height and intermediate height were statistically different preoperatively and 1 month postoperatively between the two groups (P < 0.05), but there was no statistical difference between the last follow-up and 1 month postoperatively (P > 0.05); no statistical difference was found between the two groups at the last follow-up (P > 0.05). (3) The leakage rate of bone cement was 7.7% (15/194) in the unipedicular group and 8.1% (19/234) in the bipedicular group and no statistical difference was found between the two groups (P > 0.05). (4) No statistical difference could be found in the incidence of adjacent non-surgical vertebral fractures in the unipedicular (9.1%, 16/175) and bipedicular groups (6.3%, 13/208) (P > 0.05). (5) It is concluded that compared with the bipedicular approach to percutaneous kyphoplasty, the unipedicular approach for osteoporotic vertebral compression fracture has satisfactory clinical effects, can effectively reduce the operation time, intraoperative blood loss, bone cement injection volume and risk of bone cement leakage.

Key words: osteoporotic vertebral compression fracture, percutaneous kyphoplasty, unipedicular approach, bipedicular approach, outcome, complication