Unilateral versus bilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures

Abstract

Background:The debate on the efficacy of unilateral percutaneous kyphoplasty (UPKP) and bilateral percutaneous kyphoplasty (BPKP) for the treatment of osteoporotic vertebral compression fractures (OVCFs) is ongoing.This meta-analysis aimed to evaluate the clinical results of UPKP and BPKP in the treatment of OVCFs.Methods:Web of Science, PubMed, Embase, and the Chinese Biomedical Database publication databases were searched using a date range of January 2008 to November 2016, for studies comparing UPKP and BPKP for the treatment of OVCFs. The clinical effectiveness was assessed by comparing perioperative outcomes (surgery time, the volume of injected cement, X-ray exposure time, and kyphotic angle reduction), clinical outcomes (visual analogue scale [VAS] for pain relief and Oswestry Disability Index [ODI] for quality of life), and surgery-related complications (cement leakage and adjacent vertebral fractures). Data were analyzed using Stata/SE11.0 software.Results:Fourteen trials with 1194 patients were retrieved. The pooled results showed significant differences in surgery time (weighted mean difference [WMD] −21.44, 95% confidence interval [CI] [−23.57 to −19.30]; P < .001); volume of injected cement [WMD −1.90, 95% CI [−2.26 to −1.54); P < .001); and X-ray exposure time (WMD −13.66, 95%CI [−19.59 to −7.72]; P < .001) between UPKP and BPKP treatments. However, the pooled results showed no significant differences in kyphotic angle reduction, VAS in the short-term, VAS in the long-term, ODI, cement leakage, or adjacent vertebral fractures between the 2 surgical procedures. Following a subgroup analysis, the results based on randomized controlled trials (RCTs) indicated that there were significant differences in surgery time (WMD −24.65, 95%CI [−26.53 to −22.77]; P < .001) and the volume of injected cement (WMD −1.66, 95%CI [−1.97 to −1.36]; P < .001) between UPKP and BPKP treatment procedures, respectively. The results based on RCTs indicated that there were no significant differences, either in kyphotic angle reduction or in X-ray exposure time, between the 2 surgical procedures.Conclusions:Compared to BPKP procedures, UPKP procedures may achieve similar clinical results in the treatment of OVCFs when assessed in terms of the pain relief, improvements in life quality, and surgery-related complications. However, UPKP procedures had a shorter operation time and volume of injected cement compared with BPKP procedures. Additional high quality and multicenter RCTs are needed to provide further robust evidence.

Unilateral versus bilateral percutaneous balloon kyphoplasty for osteoporotic vertebral compression fractures

“…[ 20 – 28 ] Meta-analyses were published between 2013 and 2017, with the sizes of included studies ranging from 5 to 14 RCTs or quasi-RCTs. Among them, 5 meta-analyses [ 20 , 23 – 25 , 27 ] had no restrictions of language search, 2 [ 21 , 22 ] only included meta-analysis published in English, and others did not report relevant data. The latest retrieval and publication date was November, 2016 and 26 March 2017, respectively, which were presented in a meta-analysis performed by Chang et al [ 27 ] Two meta-analyses [ 24 , 25 ] were published in Journal of Pain Physician , and remains were published in different magazines including Chinese Medical Journal, Orthopedics, Clinical Orthopaedics and Related Research, Journal of Orthopaedic Research, Acta Orthopaedica et Traumatologica Turcica, and Medicine .…”

“…[ 20 – 28 ] In total, 9 meta-analyses [ 20 – 28 ] were conducted with a comprehensively searching for original literatures in PubMed and the Cochrane Library. Of the 9 meta-analyses, 7 [ 20 – 22 , 24 – 27 ] searched Embase, only 2 [ 22 , 23 ] for Web of Knowledge, 2 [ 25 , 26 ] for OVID, 2 [ 23 , 28 ] for Wanfang data, and 4 [ 21 , 23 , 27 , 28 ] searched CBM. There was inconsistent as to whether literatures searched CINAHL, Web of Science, Bandolier, SinoMed, CNKI, and China Academic Journals Full-text Database.…”

“…[ 20 – 28 ] All 9 included meta-analyses included RCTs or quasi-RCTs with level II or III of evidence. Among them, 2 meta-analyses [ 21 , 22 ] declared that they adopted GRADE in the research process, 6 [ 21 – 25 , 28 ] followed PRISMA, 7 [ 20 – 22 , 24 – 26 , 28 ] performed pool analyses using Revman, and only 2 [ 23 , 27 ] used Stata/SE software (StataCorp, CollegeStation, TX).…”

“…AMSTAR outcomes for each item from 9 included meta-analyses were presented in Table 6 . [ 20 – 28 ] AMSTAR scores of included 9 meta-analyses varied from 8 to 9 with a median of 8.55 (mean 8.5), of which 4 meta-analyses [ 20 , 21 , 25 , 26 ] receiving 8 scores, and others [ 22 – 24 , 27 , 28 ] receiving 9. Finally, a meta-analysis by Feng et al [ 20 ] met 9 items of eleven criteria of the AMSTAR with the highest quality literature.…”

Percutaneous kyphoplasty combined with zoledronic acid infusion in the treatment of osteoporotic thoracolumbar fractures in the elderly

“… 6 However, it is not appropriate for elderly patients due to high risk of hypostatic pneumonia, decubitus ulcers and venous thromboembolism. 7 Since the late 1980s, percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) have gradually become the most popular treatments of OVCFs for quickly relieving pain and achieving spinal stabilization. 8 PKP, firstly reported by Garfin et al in 1998, was introduced to correct the spinal kyphotic deformity and restore the vertebral height via balloon expansion.…”