Comparison of Efficacy of Percutaneous Vertebroplasty versus Percutaneous Kyphoplasty in the Treatment of Osteoporotic Vertebral Asymmetric Compression Fracture

Percutaneous Curved Vertebroplasty Versus Unilateral Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures: A Systematic Review and Meta-Analysis

BACKGROUND

Percutaneous curved vertebroplasty (PCVP), a modified traditional unilateral percutaneous vertebroplasty (UPVP) technique, is increasingly being used to treat osteoporotic vertebral compression fractures (OVCFs); however, its advantages remain controversial. This meta-analysis was conducted to determine whether PCVP is superior to traditional UPVP in treating OVCFs.

METHODS

Six databases were searched for studies comparing the clinical efficacy of PCVP and UPVP in treating patients with OVCFs published until March 2023. After study selection, data extraction, and risk of bias evaluation, a meta-analysis was conducted. The study protocol was registered in the PROSPERO platform (registration number: CRD42023417190).

RESULTS

Eight studies (6 randomized controlled trials and 2 cohort studies) were eligible for the final analysis. The pooled results revealed no between-group differences in operation time (P = 0.85), intraoperative fluoroscopy (P = 0.58), or postoperative short-term visual analog scale scores (P = 0.15). However, PCVP was associated with more injected cement (P = 0.003), a lower cement leakage rate (P = 0.006), and a lower final follow-up visual analog scale score (P < 0.0001).

CONCLUSIONS

PCVP was superior to UPVP in terms of reducing the bone cement leakage rate and providing long-term pain relief. Further trials with larger sample sizes and longer follow-up periods are required to verify these findings owing to the potential risk of bias.

Robot-Assisted Kyphoplasty versus Fluoroscopy-Assisted Kyphoplasty: A Meta-Analysis of Postoperative Outcomes

Osteoporotic vertebral compression fractures are the most common manifestation of osteoporosis. Percutaneous kyphoplasty (PKP) can lead to both pain improvement and correction of kyphosis secondary to collapsed vertebral bodies. Robot-assisted (RA) PKP has been reported to provide better vertebral body fracture correction than conventional fluoroscopy-assisted (FA) PKP. The aim of this meta-analysis is to compare clinical outcomes of RA PKP versus FA PKP. The Pubmed, Embase, and MEDLINE electronic databases were searched from January 1900 to December 2022, with no language restrictions for relevant articles. We extracted the preoperative and postoperative mean pain score and standard deviation from the included studies and pooled them using an inverse variance method. Statistical analyses were performed using functions available in the metafor package in R software. The results of this meta-analysis were summarized with weighted mean differences (WMDs). Our search strategy identified 181 references from the Pubmed, Embase, and MEDLINE electronic databases. We excluded duplicates and irrelevant references, after screening titles and abstracts. The remaining 12 studies were retrieved for full-text review, and, finally, we included five retrospective cohort studies from 2015 to 2021, comprising 223 patients undergoing RA PKP and 246 patients undergoing FA PKP. No difference was found in subgroup analysis based on the timing of postoperative pain assessment, despite the overall estimate of postoperative pain indicating a significant difference between the RA PKP and FA PKP groups (WMD, −0.22; 95% CI, −0.39 to −0.05). The long-term pain assessment revealed a significantly lower VAS in the RA PKP group than the FA PKP group at six months postoperatively (WMD, −0.15; 95% CI, −0.30 to −0.01), but no difference between the subgroups at three (WMD, 0.06; 95% CI, −0.41 to −0.54) and twelve months (WMD, −0.10; 95% CI, −0.50 to 0.30) postoperatively. Our meta-analysis revealed no significant difference in postoperative pain between RA PKP and FA PKP. Patients undergoing RA PKP had better pain improvement compared to FA PKP at 6 months postoperatively. However, further studies focusing on long-term outcomes in patients undergoing RA PKP are warranted to clarify its benefit, given the small number of included studies.