Analysis of two minimally invasive procedures for osteoporotic vertebral compression fractures with intravertebral cleft: a systematic review and meta-analysis

Wei, Hongyu; Dong, Chunke; Zhu, Yuting; Ma, Hu

doi:10.1186/s13018-020-01938-6

Cited by 10 publications

(6 citation statements)

References 43 publications

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“…As compared to our pooled results, KP was associated with signi cantly longer operation time versus the VP, which is consistent with the latest meta-analysis by Hongyu Wei (26). One possible explanation is the need of more complex procedures with KP, such as the repeated establishment of expander channel on the pedicle.…”

Section: Discussionsupporting

confidence: 91%

Comparison Between Percutaneous Kyphoplasty And Percutaneous Vertebroplasty In Terms of The Efficacy For Osteoporotic Vertebral Compression Fractures: A Meta-Analysis

Zhu¹,

Ding²,

Wang³

et al. 2021

Preprint

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Background & Aim: Osteoporotic vertebral compression fractures (OVCFs) are acknowledged as common occurred fractures among humans, especially for the elderly population. The minimally invasive percutaneous methods such as kyphoplasty as well as vertebroplasty have been valid and effective tools in terms of reducing clinical problems, which are associated with more beneficial effects as compared to traditional methods such as open surgery or conservative treatment. Hence, we conducted the current meta-analysis in order to gather updated evidence available for the systematical assessment of the clinical and radiographic outcomes of VP in comparison of KP.Methods: Publications on comparison kyphoplasty versus vertebroplasty in treatment of OVCFs were collected. After rigorous and thorough review of quality, we extracted the data on the basis of eligible trials, which analyzed the summary hazard ratios (HRs) of the endpoints of interested.Results: Totally, our inclusion criteria involved five studies. 561subjects involving 334 patients received VP and 227 patients received KP were included, of which patients receiving KP or VP failed to show any significant differences in the visual analog scale (VAS) scores (MD =-0.02, 95% CI -0.40 – 0.35; P = 0.91),and the risk of cement leakage (OR =1.60, 95% CI 0.82 – 3.12; P = 0.17). Nevertheless, the Oswestry Disability Index (ODI) scores (MD =-1.56, 95% CI -2.39 – -0.73; P = 0.0002), the injected cement volume (MD =-0.40, 95% CI -0.77 – -0.04; P = 0.03) and the operation time (MD =-9.67, 95% CI -11.55 – -7.80; P ＜0.00001) in VP group were linked to markedly lower trend in comparison of KP group with significant statistical difference.Conclusion: The present meta-analysis controls the acceptable level of the efficacy across the involved trials. The VP had ODI scores, the injected cement volume and the operation time exerted several advantages in this meta-analysis. Yet, VP failed to show benefits in terms of the VAS scores and cement leakage in comparison of KP therapy. Given the combined results of our study, the optimal treatment for patient harboring OVCFs should be determined by further high-quality and multi-center RCTs along with longer follow-ups as well as larger sample size.

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Section: Discussionsupporting

confidence: 91%

Comparison Between Percutaneous Kyphoplasty And Percutaneous Vertebroplasty In Terms of The Efficacy For Osteoporotic Vertebral Compression Fractures: A Meta-Analysis

Zhu¹,

Ding²,

Wang³

et al. 2021

Preprint

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“…Both methods are safe and effective for the treatment of vertebral body compression, but neither are perfect. The PMMA hardens quickly and behaves as a cast [57,58], especially in patients with an IVC.…”

Section: Discussionmentioning

confidence: 99%

Is Kummell’s Disease a Misdiagnosed and/or an Underreported Complication of Osteoporotic Vertebral Compression Fractures? A Pattern of the Condition and Available Treatment Modalities

Adamska

Modzelewski

Stolarczyk

et al. 2021

JCM

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This narrative review provides the outcomes of minimally invasive surgery (MIS) and describes the available conservative treatment options for patients with osteoporotic vertebral compression fractures (OVCFs) that have risk factors for Kummell’s disease (KD). It aims to explore the evidence, emphasize the possible therapy complications, and aims to propose the most efficient clinical strategies for maintaining a good overall condition of individuals who may suffer from neurological deficits from a late-diagnosed OVCF complication. The secondary objective is to sum up the diagnostic particularities concerning individuals prone to OVCFs and KD, as the major risk factor for developing these severe conditions remains osteoporosis. Findings of our narrative review are based on the results found in PubMed, Embase, and Google Scholar from the beginning of their inception to December 2020, described independently by two authors. All of the studies included in the review focus on reporting the following treatment methods: conservative methods, vertebroplasty, kyphoplasty, targeted percutaneous vertebroplasty, frontal and side-opening cannula vertebroplasty, SpineJack, bone-feeling mesh container treatment, and the difference in the cement viscosity used (high vs. low) and the approach used (unilateral vs. bilateral). The comparison of randomized control trials (RCTs) as well as prospective and retrospective case series showed a comparable efficacy of kyphoplasty and vertebroplasty, and described cement-augmented screw fixation and the SpineJack system as effective and safe. Although it should be noted that several studies revealed inconsistent results in regards to the efficacy of using back braces and analgesics in patients who had vertebral fractures that were overlooked or not enrolled in any active surveillance program to track the patient’s deterioration immediately. Nevertheless there are non-standardized guidelines for treating patients with OVCFs and their complications already established. Using these guidelines, a treatment plan can be planned that takes into consideration the patients’ comorbidities and susceptibilities. However, the primary approach remains the management of osteoporosis and that is why prophylaxis and prevention play a crucial role. These measures reduce the risk of disease progression. Unfortunately, in the majority of cases these measures are not taken into account and KD develops.

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“…A recent meta-analysis involving 7 RCTs (929 subjects) concluded that ZA in combination with PVP or PKP is a safe, effective, and comprehensive treatment for OVF [46,47]. The addition of ZA significantly improved the long-term analgesia and bone metabolism indices [including BMD, β-isomerized Cterminal telopeptide and N-terminal propeptide of type I collagen; and Nterminal molecular fragment levels].…”

Section: Is It Safe To Add Zoledronate (Za) To Pvp or Pkp?mentioning

confidence: 99%

Vertebral fragility fractures in osteoporosis – A comprehensive review on its management

Viswanathan,

Kanna,

Shetty

2022

Jcorth

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Introduction: Approximately 20% of individuals older than 50 years of age have been reported to present with vertebral fragility fractures (VFF) – a prevalence which is anticipated to steadily increase in future. VFF is associated with disabling pain, significant impairment of quality of life, reduced ambulatory capacity, impaired social interactions, and poor quality of sleep. Early detection, appropriate management, evaluation of osteoporosis, and prevention of future fragility fractures would form the crux of treatment. Nevertheless, there is no consensus on what constitutes the ideal management protocol for symptomatic VFF. Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used to prepare this review. A detailed review of the literature was performed using PubMed, EMBASE, MEDLINE, and Cochrane Database of Systematic Reviews, which were searched for eligible studies with terms “treatment of VEF,” “osteoporotic vertebral fracture (OVF),” “management of osteoporotic compression fracture,” “imaging in OVF,” “percutaneous vertebral augmentation,” and “conservative treatment of OVF” from inception to November 2021. Duplicate studies, case reports, and letters to the editor were excluded from the study. Results: A total of 286 studies were identified using our search criteria. Of these, 142 were duplicates and 107 did not meet inclusion criteria. After removal of these articles through various stages of screening, a total of 37 studies were finally included in the review. Plain radiographs, computed tomography (CT), and magnetic resonance imaging (MRI) are helpful in the diagnosis, evaluation, and management of these fractures. Radiologically, unstable VFFs need to be identified based on the following criteria (>50% vertebral height loss, kyphosis ≥25–35°, substantial retropulsion of bony fragments, significant bony, or ligamentous posterior column injuries). Conservative treatment (which includes analgesics, orthoses, and early mobilization) has remained the traditional way of treating these fractures. More recent systematic reviews have demonstrated a significant improvement in early pain control, vertebral height restoration, and ambulation with percutaneous augmentation (PKP or PVP) procedures. These studies have recommended cement augmentation in patients with intractable pain, not responding to medications. Surgical stabilization is recommended in elderly patients with pseudoarthrosis, substantial intervertebral instability, intractable pain with vertebral collapse, neurological deficit, and kyphosis. The need for long-term medical therapy to improve the bone density cannot be understated. Conclusion: A high index of suspicion is necessary to diagnose VFFs in elderly patients with back pain. Conservative treatment has remained the traditional way of treating these fractures. Recent evidence shows early pain control and better vertebral height restoration with cement augmentation procedures (PKP or PVP). Open surgical stabilization can be helpful in a subset of patients with substantial intervertebral instability, deformity, and neuro-deficit.

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Analysis of two minimally invasive procedures for osteoporotic vertebral compression fractures with intravertebral cleft: a systematic review and meta-analysis

Cited by 10 publications

References 43 publications

Comparison Between Percutaneous Kyphoplasty And Percutaneous Vertebroplasty In Terms of The Efficacy For Osteoporotic Vertebral Compression Fractures: A Meta-Analysis

Comparison Between Percutaneous Kyphoplasty And Percutaneous Vertebroplasty In Terms of The Efficacy For Osteoporotic Vertebral Compression Fractures: A Meta-Analysis

Is Kummell’s Disease a Misdiagnosed and/or an Underreported Complication of Osteoporotic Vertebral Compression Fractures? A Pattern of the Condition and Available Treatment Modalities

Vertebral fragility fractures in osteoporosis – A comprehensive review on its management

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