Interventions
vertebral fracture, osteoporosis
OSTEOPOROSIS, PERIOSTEUM
Based on computer-generated random numbers, we randomly assigned enrolled patients to undergo unilateral balloon kyphoplasty either by an extrapedicular approach (treatment group) or a transpedicular approach (control group). Individuals were blinded to the assigned group throughout their hospital stay and follow-up. All surgical interventions were performed by the same surgeon aware of patient information and corresponding assignment.For the treatment group, the highlight of the extrapedicular approach was that the insertion site was located on the superolateral periosteum relative to the pedicle, which could provide a higher puncture angle on both the sagittal and horizontal plane (Fig. Kyphoplasty by unilaterally extrapedicular approach. For the control group, all patients received unilaterally transpedicular balloon kyphoplasty. We did not allow conversion to bipedicular kyphoplasty even if the unilateral injection failed to achieve adequate instillation of cement, which could improve the comparability between groups. The surgical procedures were done according to standard practices of introducer instruments.Following the surgery, all patients stayed in the hospital for 1–2 days and received ancillary care (e.g., osteoporosis drugs, back braces, analgesics, and physiotherapy) when necessary. A subsequent vertebral fracture was treated as the initial assignment.