title: Comparison of Unilateral versus Bilateral Kyphoplasty in Multiple Myeloma Patients and the Importance of Preoperative Planning.
abstract: METHODS
  Retrospective comparative study and technical note.
  
  
  OBJECTIVE
  To determine if there is a difference in clinical and radiographic parameters between unilateral and bilateral kyphoplasty in a uniform cancer population and to stress the importance of preoperative planning.
  
  
  BACKGROUND
  While unipedicular kyphoplasty is gaining popularity, a few comparative studies have reported on superior kyphotic reduction with the bipedicular approach.
  
  
  METHODS
  We reviewed 69 myeloma patients with 105 operated levels (51 levels were done bilaterally vs. 54 unilaterally). Pain reduction, height restoration, cement volume and complications were recorded up to three months postoperatively. A technical note to identify the skin entry point on the basis of the magnetic resonance imaging and fluoroscopy (lateral view) is being described.
  
  
  RESULTS
  Both procedures resulted in significant pain reduction (5.4-5.6/10 points, p=0.8). There was significant height restoration after the operation (p<0.001), while there was no sustained difference between the procedures (p=0.5) up to three months postoperatively. More cement was injected in the bilateral group (4.1 mL vs. 4.9 mL, p=0.002); no difference in cement extravasation in the spinal canal was observed (p=0.5).
  
  
  CONCLUSIONS
  There was no difference in the clinical or radiological outcomes between the unilateral and bilateral approaches. Therefore, unilateral kyphoplasty may be performed whenever it is technically feasible and this may be determined preoperatively.
authors: Neurosurgical Department, H. Lee Moffitt Cancer Center, Tampa, FL, USA. ; General Oncological Hospital "Agioi Anargyroi", Athens, Greece.
authors: Ioannis D
authors: ID
authors: Papanastassiou
authors: Neurosurgical Department, H. Lee Moffitt Cancer Center, Tampa, FL, USA. ; Neurosurgical Department, G.V. (Sonny) Montgomery VA Medical Center, Jackson, MS, USA.
authors: Mohamed
authors: M
authors: Eleraky
authors: Radiology Department, H. Lee Moffitt Cancer Center, Tampa, FL, USA.
authors: Ryan
authors: R
authors: Murtagh
authors: First Department of Orthopaedics, Athens University Medical School, Athens, Greece.
authors: Zinon T
authors: ZT
authors: Kokkalis
authors: Department of Dermatology, "Andreas Syngros" Hospital, Athens, Greece.
authors: Maria
authors: M
authors: Gerochristou
authors: Neurosurgical Department, H. Lee Moffitt Cancer Center, Tampa, FL, USA.
authors: Frank D
authors: FD
authors: Vrionis
keywords: Compression fracture; Kyphoplasty; Magnetic resonance imaging; Multiple myeloma; Unilateral