I took my father in for an appointment with the spinal surgeon. Dad has two compression fractures in his mid-back area. The physician’s assistant showed us how they will insert a needle into the bone, puff up the area with a balloon, and then inject cement. She mentioned something about only doing it from one side being a better way to go. That went by me completely. What was she talking about?

Compression fractures are the most common type of fracture affecting the spine. Multiple-level vertebral compression fractures are commonly the result of osteoporosis. Spine bones weakened from osteoporosis (brittle bones) may become unable to support normal stress and pressure. As a result, something as simple as coughing, twisting, or lifting can cause a vertebra to fracture.

That’s where a balloon kyphoplasty comes in. Long needles are inserted through one or both sides of the spinal column into the fractured vertebral body. These needles guide the surgeon while drilling holes into the vertebral body. The surgeon uses a fluoroscope (special 3-D real-time X-rays) to make sure the needles and drill holes are placed in the right spot.

The surgeon then slides a hollow tube with a deflated balloon on the end through the drill hole. Inflating the balloons restores the height of the vertebral body and corrects the kyphosis deformity.

Before the procedure is complete, the surgeon injects bone cement into the hollow space formed by the balloon. The cement is injected a little bit at a time until the cavity is filled. They try to keep most of the cement in the front three-fourths of the vertebral body. This fixes the bone in its corrected size and position and supports the front part that has collapsed the most.

This procedure halts severe pain and strengthens the fractured bone. However, it also gives the advantage of improving some or all of the lost height in the vertebral body, helping prevent or correct kyphosis.

As you have just found out, this procedure can be done by inserting the needle from one side (unilateral) of the vertebral bone or from both sides (bilateral). There are potential advantages and disadvantages with both techniques.

Safety is always an issue with any spinal procedure. Inserting needles from both sides of the spine has the potential to create more problems and complications compared with a unilateral approach.

The idea of doing the procedure from both sides is that this would provide a more even lift of the collapsed vertebra. Another potential advantage of the bilateral injection is to create a large cavity to inject as much cement as possible.

On the other hand, a unilateral approach takes less time. This advantage translates into money that can be saved with shorter operative procedures. With less time required to complete the kyphoplasty, the patient is exposed to less radiation from X-rays (fluoroscopy).

A unilateral approach reduces the risk of puncturing nerves or blood vessels with the needles. Inserting one instead of two needles also reduces the chances of fracturing a bone unintentionally.

Studies show that the unilateral approach is both safe and effective. Strength of vertebral repair and stiffness are not compromised in any way. According to one recent study, all corrections made through this procedure are maintained for at least two years.