Therapeutic Efficacy of Third-Generation Percutaneous Vertebral Augmentation System (PVAS) in Osteoporotic Vertebral Compression Fractures (OVCFs): A Systematic Review and Meta-analysis

Abstract

Purpose. This study aimed to assess whether the third-generation PVAS was superior to percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) in treating patients with OVCFs. Methods. Databases, including Pubmed, Embase, and Cochrane library, were searched to identify relevant interventional and observational articles in vivo or in vitro comparing the third-generation PVAS to PVP/PKP in OVCFs patients. A meta-analysis was performed under the guidelines of the Cochrane Reviewer’s Handbook. Results. 11 in vivo articles involving 1035 patients with 1320 segments of diseased vertebral bodies and 8 in vitro studies enrolling 40 specimens with 202 vertebral bodies were identified. The vivo studies indicated no significant differences were found in visual analog scale (VAS), Oswestry Disability Index (ODI), operation time, or injected cement volume ( P > 0.05 ). The third-generation PVAS was associated with significant improvement in vertebral height and Cobb angle ( P < 0.05 ) and also with a significantly lower risk of cement leakages and new fractures ( P < 0.05 ). The vitro studies suggest that the third-generation PVAS was associated with better anterior vertebral height (AVH) and kyphotic angle (KA) after deflation and cement. No significant differences were found in stiffness or failure load after cement between the two groups ( P > 0.05 ). Conclusion. Based on current evidence, although providing similar improvement in VAS and ODI, the third-generation PVAS may be superior to PVP/PKP in local kyphosis correction, vertebral height maintenance, and adverse events reduction. Further high-quality randomized studies are required to confirm these results.

Multilevel posterior spinal fusion following percutaneous third generation kyphoplasty complicated by vertebral compression fracture progression

“…Third generation kyphoplasty indefinitely restores vertebral height using an expandable scaffold through a mechanical rather than hydraulic opening control prior to injection of the cement. Due to the implantation of a permanent intervertebral scaffold for height maintenance, studies have shown that third generation PK are associated with lower rates of new fractures and a larger postoperative increase in vertebral heights when compared with traditional kyphoplasty [ 5 , 6 ]. Spine Jack® (Stryker Corp, Kalamazoo, MI) specifically may be associated with reduced cement leakage and adjacent vertebral body fractures, along with reduction of the superior endplates allowing for better recovery of the injured disk [ 7 ].…”

Advances in materials used for minimally invasive treatment of vertebral compression fractures

“…Unlike minimally invasive injectable cement materials, vertebral implants are primarily composed of implantable metals (Cornelis et al, 2019) (Figure 7). These include the Vertebral Body Stenting (VBS), SpineJack, Kiva, and Osseofix systems, which are based on a similar principle of percutaneous implantation of an expandable vertebral body stent (to restore vertebral height) and the correction of kyphosis; this procedure is referred to as third-generation vertebral body augmentation (Dong et al, 2022).…”

A novel device with pedicular anchorage provides better biomechanical properties than balloon kyphoplasty for the treatment of vertebral compression fractures

“…Worldwide, 1.4 million cases of vertebral compression fractures (VCFs) are estimated to occur each year [ 9 ]. Percutaneous vertebroplasty (PVP) has traditionally been performed to treat VCF; however, guidelines from the American Academy of Orthopedic Surgeons strongly recommend against its use, due to its uncertain benefits and known harms [ 17 ]; instead, other surgical treatments are now commonly performed on their own or in combination with cement injection, including percutaneous balloon kyphoplasty (PBKP) and percutaneous vertebral augmentation systems (PVAS) [ 2 , 5 , 8 , 11 ]. These surgical treatments intend to restore and maintain vertebral body height and reduce kyphosis, which in turn decreases low back pain and reduces the risk of mortality [ 2 , 10 ].…”

“…A number of studies have found no clinically relevant differences between PVP, PBKP, and PVAS in their ability to restore vertebral body height and reduce kyphosis, and maintain it in the long-term [ 4 , 7 , 12 , 16 ]. Furthermore, a recent meta-analysis [ 5 ] stated that it is unclear whether PVAS is superior to PBKP or PVP in terms of pain relief and functional improvement. Korovessis et al [ 12 ] compared anterior vertebral body height preoperatively versus at 13–15 months follow-up for PBKP and PVAS, and found an increase of only 23% and 24% respectively, with no significant differences between treatment groups.…”