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Vertebroplasty versus kyphoplasty in osteoporotic vertebral compression fracture: a meta-analysis of prospective comparative studies

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Abstract

Purpose

The goal of this article is to evaluate the efficacy and the safety of the percutaneous vertebroplasty (PVP) versus percutaneous kyphoplasty (PKP) in dealing with the osteoporotic vertebral compression fracture (OVCF).

Methods

In July 2014, a comprehensive systematic computer-based online search was performed by using the databases of PubMed, EMBASE, Cochrane Library, Web of Science, Wan Fang, and the China Biological Medicine. Only prospective comparative trials (PCT) and randomized controlled trials (RCT) that compared PVP with PKP were included. Trials were screened based on the inclusion and exclusion criteria previously formed. The Cochrane collaboration guidelines were also used to assess the quality of these included studies. The primary data of these studies [volume of the cement, postoperative vertebral height, visual analog scale (VAS) score and Oswestry Disability Index (ODI) score after the surgery, and so on] were carefully abstracted and processed by Revman 5.2.0 software The publication bias of the main results (cement leakage and adjacent-level fracture) were examined by Stata 12.0 (Begg and Egger test). Furthermore, the stability of the main results were also detected by sensitivity and cumulative analyses.

Results

Six RCT and 14 PCT studies involving 1,429 patients met our criteria and were included finally. Comparing these two methods, the PKP group took more operation time [SMD = 0.66, 95 % CI (0.28, 1.03), p = 0.0006] with higher anterior vertebral body height [SMD = 1.40, 95 % CI (0.49, 2.32), p = 0.003], greatly reduced Cobb angle in the long run [SMD = −0.61, 95 % CI (−1.04, −0.19), p = 0.005] and had lower risk of cement leakage. However, in VAS scores and ODI scores after the surgery whether for the short-term efficacy (no more than 1 week after the surgery) or long-term efficacy (more than six months), Cobb angle in the short run and new fracture in the adjacent level, no statistically differences were found between the two groups.

Conclusions

Based on current evidence, PVP takes less time in the operation, while it has greater risk of cement leakage, was inferior in reducing Cobb angle in the long term and results in lower anterior vertebral body height after the surgery. For pain relief, which is the main desire of the patients, both procedures provide significant improvement in VAS and ODI pain scores. PVP is still an effective procedure.

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Authors and Affiliations

  1. Department of Orthopedics, Xinqiao Hospital, The Third Military Medical University, Chongqing, 400037, People’s Republic of China

    Xian Chang, Bin Chen, Hai-yin Li, Xiao-bo Han, Kuang Yang, Wei Zhang, Yue Zhou & Chang-qing Li

  2. Department of Pathology, Xinqiao Hospital, The Third Military Medical University, Chongqing, 400037, People’s Republic of China

    Yang-Fan Lv

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  1. Xian Chang
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Correspondence to Chang-qing Li.

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Xian Chang and Yang-Fan Lv contributed equally to this work

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Chang, X., Lv, YF., Chen, B. et al. Vertebroplasty versus kyphoplasty in osteoporotic vertebral compression fracture: a meta-analysis of prospective comparative studies. International Orthopaedics (SICOT) 39, 491–500 (2015). https://doi.org/10.1007/s00264-014-2525-5

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  • DOI: https://doi.org/10.1007/s00264-014-2525-5

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