Clinical and radiological outcomes of balloon kyphoplasty: lateral decubitus versus prone positioning: a retrospective comparative study

Osteoporotic vertebral compression fractures are common in the elderly, leading to pain, disability, and reduced quality of life. Balloon kyphoplasty (BK) is a minimally invasive treatment for osteoporotic vertebral compression fractures, typically performed in the prone position. However, the prone position is not suitable for patients with severe comorbidities, such as morbid obesity. The lateral decubitus position has emerged as an alternative, although limited data exist on its short-term outcomes. This study aims to compare the short-term clinical, radiological, and intraoperative outcomes of unipedicular balloon kyphoplasty (BK) performed in the prone position versus the lateral decubitus position, particularly in patients with contraindications to prone positioning, including morbid obesity and associated medical comorbidities. In a retrospective study, 50 patients aged over 65 who underwent unipedicular BK under local anesthesia between 2021 and 2024 were divided into 2 groups: 25 in the prone position and 25 in the lateral decubitus position due to contraindications for prone positioning. Pain levels were assessed using the visual analog scale at 5 time points: preoperatively, postoperative day 1, month 1, month 3, and month 6. Fluoroscopy time, surgeon comfort, and technical difficulty were measured using the Surgical Comfort and Difficulty Index. Radiological outcomes, including vertebral height loss at 6 months, were also recorded. The results indicated that patients in the lateral decubitus position experienced significantly lower postoperative pain on day 1 (visual analog scale: 2.6 vs 3.4, P  = .02) and had shorter fluoroscopy times (81.5 vs 95.2 seconds, P  = .01). The lateral decubitus group also reported lower Surgical Comfort and Difficulty Index scores, indicating improved surgeon comfort (3.9 vs 5.6, P  = .001). However, radiological vertebral height loss at 6 months was similar between the groups. There were no major complications, with 1 patient in each group experiencing asymptomatic cement extravasation. Unipedicular BK performed in the lateral decubitus position provides clinical and radiological outcomes comparable with the prone position. In selected patients with contraindications to prone positioning, the lateral decubitus approach may represent a safe and effective alternative.