Predictive risk factors for recollapse of cemented vertebrae after percutaneous vertebroplasty: A meta-analysis

Abstract

BACKGROUND As one of the most common complications of osteoporosis, osteoporotic vertebral compression fracture (OVCF) increases the risk of disability and mortality in elderly patients. Percutaneous vertebroplasty (PVP) is considered to be an effective, safe, and minimally invasive treatment for OVCFs. The recollapse of cemented vertebrae is one of the serious complications of PVP. However, the risk factors associated with recollapse after PVP remain controversial. AIM To identify risk factors for the recollapse of cemented vertebrae after PVP in patients with OVCFs. METHODS A systematic search in EMBASE, MEDLINE, the Cochrane Library, and PubMed was conducted for relevant studies from inception until March 2020. Studies investigating risk factors for the recollapse of cemented vertebrae after PVP without additional trauma were selected for analysis. Odds ratios (ORs) or standardized mean differences with 95% confidence interval (CI) were calculated and heterogeneity was assessed by both the chi-squared test and the I -squared test. The methodological quality of the included studies was assessed according to the Newcastle-Ottawa Scale. RESULTS A total of nine case-control studies were included in our meta-analysis comprising 300 cases and 2674 controls. The significant risk factors for the recollapse of cemented vertebrae after PVP in OVCF patients were fractures located at the thoracolumbar junction (OR = 2.09; 95%CI: 1.30 to 3.38; P = 0.002), preoperative intravertebral cleft (OR = 2.97; 95%CI: 1.93 to 4.57; P < 0.00001), and solid lump distribution pattern of the cement (OR = 3.11; 95%CI: 1.91 to 5.07; P < 0.00001). The analysis did not support that age, gender, lumbar bone mineral density, preoperative visual analogue scale score, injected cement volume, intradiscal cement leakage, or vertebral height restoration could increase the risk for cemented vertebra recollapse after PVP in OVCFs. CONCLUSION This meta-analysis suggests that thoracolumbar junction fractures, preoperative intravertebral cleft, and solid lump cement distribution pattern are associated with the recollapse of cemented vertebrae after PVP in OVCF patients.

Lower ratio of adjacent to injured vertebral bone quality scores can predict augmented vertebrae recompression following percutaneous kyphoplasty for osteoporotic vertebral fractures with intravertebral clefts

“…According to previous histological and radiological studies, 4,5,16 it is mainly associated with osteonecrosis, nonunion, and pseudarthrosis after OVFs. Many researchers have demonstrated that the presentation of IVCs indicated instability within the injured vertebrae in different body postures 3,5–9 . Hence, the patients suffering from OVFs with IVCs usually have severe back pain and do not respond to conservative treatments such as bed rest and medication.…”

Comparison of different approaches of percutaneous vertebroplasty in the treatment of osteoporotic spinal compression fractures and analysis of influencing factors of re-fracture

“…That may lead to unstable internal structure, which changes the ratio of PD and the anterior and posterior height of the vertebral body, and thus increases the risk of postoperative re-fracture. 19 …”

“…That may lead to unstable internal structure, which changes the ratio of PD and the anterior and posterior height of the vertebral body, and thus increases the risk of postoperative re-fracture. 19 Limitations: This is a retrospective design and shorter follow up study, and sample size is small. Therefore, there is a need for further larger studies, clinical trials and studies with longer follow-up times to evaluate the prognosis of patient.…”

Risk factors for new vertebral compression fracture after vertebroplasty and efficacy of osteoporosis treatment: A STROBE-compliant retrospective study

“…Recently, several studies have analyzed the risk factors-decreased bone mineral density (BMD), cement leakage into the disc, sagittal imbalance, the presence of an intravertebral cleft, endplate cortical disruption, and the degree of restoration of the vertebral height-associated with SNVCFs after VP. [10][11][12][13][14][15] However, the results are contradictory and remain inconclusive. Furthermore, whether SNVCFs are caused by VP or by spontaneous progression of osteoporosis is yet to be confirmed.…”