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Global Spine Journal Jun 2024Systematic review and meta-analysis. (Review)
Review
Mechanical Vertebral Body Augmentation Versus Conventional Balloon Kyphoplasty for Osteoporotic Thoracolumbar Compression Fractures: A Systematic Review and Meta-Analysis of Outcomes.
STUDY DESIGN
Systematic review and meta-analysis.
OBJECTIVE
Surgical management of osteoporotic vertebral compression fractures (OVCFs) has traditionally consisted of vertebroplasty or kyphoplasty procedures. Mechanical percutaneous vertebral body augmentation (MPVA) systems have recently been introduced as alternatives to traditional methods. However, the effectiveness of MPVA systems vs conventional augmentation techniques for OVCFs remains unclear. This serves as the premise for this study.
METHODS
A systematic review and meta-analysis was conducted as per the guidelines. Studies of interest included randomized controlled trials (RCTs) which directly compared patient outcomes following kyphoplasty to patients treated with MPVA systems. Clinical and radiological findings were collated and compared for significance between cohorts.
RESULTS
6 RCTs were identified with 1024 patients total. The mean age of all patients was 73.5 years. 17% of the cohort were male, 83% were female. 515 patients underwent kyphoplasty and 509 underwent mechanical vertebral body augmentation using MPVA systems. MPVAs showed similar efficacy for restoration of vertebral body height ( = .18), total complications ( = .36), cement extravasation ( = .58) and device-related complications ( = .06). MPVAs also showed reduced rates of all new fractures (16.4% vs 22.2%; = .17) and adjacent fractures (14.7% vs 18.9%; = .23), with improved visual analogue scale (VAS) scores at 6-month ( = .13).
CONCLUSION
The results of this meta-analysis highlight no significant improvement in clinical or radiological outcomes for MPVA systems when compared to balloon kyphoplasty for vertebral body augmentation. Further research is needed to establish a true benefit over traditional operative methods.
PubMed: 38889443
DOI: 10.1177/21925682241261988 -
Journal of Robotic Surgery Jun 2024This study systemically reviewed the effects of robot-assisted percutaneous kyphoplasty (R-PKP) on the clinical outcomes and complications of patients with osteoporotic... (Meta-Analysis)
Meta-Analysis Review
This study systemically reviewed the effects of robot-assisted percutaneous kyphoplasty (R-PKP) on the clinical outcomes and complications of patients with osteoporotic vertebral compression fracture (OVCF). The articles published from the establishment of the database to 19 April 2024 were searched in PubMed, The Cochrane Library, Web of Science, Embase, Scopus, China National Knowledge Infrastructure (CNKI), and Chinese biomedical literature service system (SinoMed). Meta-analysis was employed to evaluate the status of pain relief and complications between the control and R-PKP groups. Standardized mean difference (SMD) or mean difference (MD), risk ratios (RR), and 95% confidence interval (CI) were selected for analysis, and a common or random effect model was adopted to merge the data. Eight studies involving 773 patients with OCVFs were included. R-PKP could effectively Cobb's angles (MD = -1.00, 95% CI -1.68 to -0.33, P = 0.0034), and decrease the occurrence of cement leakage (RR = 0.36, 95% CI 0.21 to 0.60, P < 0.0001). However, there was no significant effect on the results of visual analog scale (MD = -0.09, 95% CI -0.20 to 0.02, P = 0.1145), fluoroscopic frequency (SMD = 5.31, 95% CI -7.24 to 17.86, P = 0.4072), and operation time (MD = -0.72, 95% CI -7.47 to 6.03, P = 0.8342). R-PKP could significantly correct vertebral angle and reduce cement leakage. Thus, R-PKP maybe an effective choice for correction vertebral Angle and reducing postoperative complications, while its impact on relieving pain, decreasing fluoroscopic frequency, and shortening operation time need further exploration.
Topics: Humans; Kyphoplasty; Fractures, Compression; Osteoporotic Fractures; Spinal Fractures; Robotic Surgical Procedures; Treatment Outcome; Female; Aged; Postoperative Complications; Male
PubMed: 38847956
DOI: 10.1007/s11701-024-01996-6 -
Archives of Osteoporosis May 2024Data from English randomized controlled trials comparing unilateral versus bilateral PKP for the treatment of OVCFs were retrieved and analyzed, and the results showed... (Meta-Analysis)
Meta-Analysis Review
UNLABELLED
Data from English randomized controlled trials comparing unilateral versus bilateral PKP for the treatment of OVCFs were retrieved and analyzed, and the results showed that unilateral PKP is a better choice for the treatment of patients with OVCFs, which will provide a reliable clinical rationale for the treatment of OVCFs.
PURPOSE
To investigate the advantages of unilateral percutaneous kyphoplasty (PKP) for the treatment of osteoporotic vertebral compression fractures(OVCFs).
METHODS
The systematic evaluation program met all program requirements (CRD 42023422383) by successfully passing the PROSPERO International Prospective Systematic Evaluation Registry. Researchers searched the references of English-language randomized controlled trials comparing unilateral and bilateral PKP for the treatment of osteoporotic vertebral compression fractures published between 2010 and 2023 and manually searched for known primary and review articles. The study statistically analyzed data from all the included literature, which primarily included time to surgery, visual pain score(VAS) and Oswestry disability index(ODI) at postoperative follow-up time points, polymethylmethacrylate (PMMA, bone cement) injection dose, cement leakage, radiation dose, and improvement in kyphotic angle.
RESULTS
This meta-analysis searched 416 articles published from 2010 to 2023 based on keywords, and 18 articles were finally included in this study. The results of the forest plot showed that unilateral PKP operative time, amount of bone cement used, and radiation dose to the patient were significantly reduced (p < 0.01, p < 0.01, and p < 0.01, respectively), and unilateral and bilateral PKP had comparable cement leakage (p = 0.49, 95% CI = 0.58-1.30), and there was no significant difference in the kyphotic angle between unilateral and bilateral PKP (p = 0.42, 95% CI = - 2.29-0.96). During follow-up, there was no significant difference in pain relief between unilateral and bilateral PKP (p = 0.70, 95% CI = - 0.09-0.06), nor was there a significant difference in ODI (p = 0.27, 95% CI = - 0.35-1.24).
CONCLUSIONS
There is no difference in clinical efficacy between unilateral PKP and bilateral PKP, but unilateral PKP has a shorter operative time, a lower incidence of cement leakage, a lower amount of cement, and a lower radiation dose to the patient and operator. Unilateral PKP is a better option for patients with OVCFs.
Topics: Humans; Kyphoplasty; Fractures, Compression; Osteoporotic Fractures; Spinal Fractures; Bone Cements; Treatment Outcome; Randomized Controlled Trials as Topic
PubMed: 38750277
DOI: 10.1007/s11657-024-01400-8 -
European Spine Journal : Official... May 2024As an important treatment for spinal metastasis, surgery has strict applicable conditions. Although various organizations have formulated different guidelines on... (Review)
Review
PURPOSE
As an important treatment for spinal metastasis, surgery has strict applicable conditions. Although various organizations have formulated different guidelines on surgical treatment for spinal metastasis (SM), there are certain differences in the content, standardization and quality of the guidelines and it is necessary to make a critical appraisal of them. We aim to systematically review and appraise the current guidelines on surgical treatments of SM and summarize the related recommendations with the quality evaluation of supporting evidence, as to provide a reference for the standardization of surgical treatment plans, and help clinical front-line medical workers can make safe and effective clinical decisions faster.
METHODS
We searched Pubmed, Web of Science, and Embase for three major databases and online guideline databases. According to certain inclusion and exclusion criteria, the latest guidelines on the surgical treatment of SM were sorted out. AGREE II was used to evaluated the guideline's quality, and we extracted and compared the recommended treatment content of each guideline with evaluating by the evidence-grading scale.
RESULTS
Eight guidelines from 2013 to 2019 were included. Seven guidelines are comprehensive guidelines and one related to the reconstructive surgery of SM. Five guidelines were evaluated as "recommended," and three guidelines were evaluated as "recommended with modifications." Regarding the indications of surgery with SM, four guidelines, seven guidelines, seven guidelines, three guidelines and three guidelines recommended surgical treatment for patients with SM with intractable pain, mechanical instability, metastatic epidural spinal cord compression (MESCC), recurrent spinal metastasis (RSM), and survival predication, respectively. Regarding the surgical strategies, three guidelines recommended minimally invasive therapy but had strict indications. Six guidelines and five guidelines recommend palliative surgery and with receiving radiation therapy, respectively. For the aggressive surgery, only one guideline recommended to apply to patients in good general conditions who has isolated symptomatic SM. Regarding the surgical reconstructions, one guideline didn't recommend iliac bone graft and three guidelines recommended PMMA bone cement.
CONCLUSION
Most of the guidelines do not provide clear criteria for surgical application and provide more of a basic framework. The level of evidence for these surgical recommendations ranges from LOE B to D, and almost all guidelines recommend vertebroplasty and kyphoplasty, but for palliative and more aggressive surgery, which recommended to personalize specific surgical strategies with multidisciplinary collaboration.
Topics: Humans; Practice Guidelines as Topic; Spinal Neoplasms
PubMed: 38407614
DOI: 10.1007/s00586-023-08127-z -
World Neurosurgery Apr 2024The current meta-analysis was performed to gather available evidence regarding the incidence and risk factors of cement leakage (CL) in patients undergoing surgical... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
The current meta-analysis was performed to gather available evidence regarding the incidence and risk factors of cement leakage (CL) in patients undergoing surgical procedures for spinal metastasis.
METHODS
Two authors independently searched the PubMed, Embase, and CENTRAL databases. Clinical studies reporting the incidence or risk factors of CL were included for analysis. The primary outcome analyzed was the incidence of various types of CL. Random-effects or fixed-effects single-proportion meta-analyses were conducted to pool the available evidence, based on the heterogeneity test. Subgroup analyses were conducted based on surgical procedures (percutaneous vertebroplasty, percutaneous kyphoplasty, and others). Risk factors of CL were synthesized narratively to identify the most commonly accepted factors.
RESULTS
A total of 26 studies, involving 2551 patients, were included. The number of operated spine segments was reported in 23 studies, accounting for 4101 vertebrae. The pooled incidences of general, intradiscal, paravertebral, spinal canal, and intravascular CLs were 0.18 (95% confidence interval [CI], 0.11-0.28), 0.14 (95% CI, 0.08-0.21), 0.13 (95% CI, 0.06-0.21), 0.11 (95% CI, 0.05-0.19), and 0.12 (95% CI, 0.08-0.17), respectively. Subgroup analyses revealed significantly different incidences of general CL (0.37 vs. 0.06 vs. 0.09, P < 0.01), intradiscal CL (0.22 vs. 0.06 vs. 0.12, P < 0.01), paravertebral CL (0.25 vs. 0.03 vs. 0.06, P < 0.01), and vascular CL (0.14 vs. 0.03 vs. 0.15, P < 0.01) among the three groups. Posterior wall disruption, pathologic fracture, and the number of treated vertebral levels were the most commonly identified independent risk factors for general CL. Posterior wall disruption was determined as a common significant risk factor for spinal canal CL.
CONCLUSIONS
This review provides insights into the incidence and risk factors associated with CL in surgical procedures for spinal metastasis. Understanding these risk factors can contribute to the development of tailored strategies aimed at minimizing CL occurrence and optimizing surgical outcomes for patients undergoing spinal metastatic surgery.
Topics: Humans; Vertebroplasty; Incidence; Spinal Neoplasms; Spinal Fractures; Fractures, Compression; Bone Cements; Kyphoplasty; Risk Factors; Osteoporotic Fractures; Treatment Outcome
PubMed: 38246530
DOI: 10.1016/j.wneu.2024.01.065 -
Neurospine Dec 2023We aimed to comprehensively compare surgical methods for osteoporotic vertebral compression fracture (OVCF) using systematic review and network meta-analysis to...
OBJECTIVE
We aimed to comprehensively compare surgical methods for osteoporotic vertebral compression fracture (OVCF) using systematic review and network meta-analysis to understand their effectiveness and outcomes, as current research provides limited overviews.
METHODS
We followed PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines, preregistering our protocol with PROSPERO. We analyzed Englishpublished randomized controlled trials (RCTs) on adults with OVCFs that evaluated pain intensity or functionality using tools like visual analogue scale (VAS) or Oswestry Disability Index (ODI). Exclusions included non-RCTs, malignancy-related fractures, and certain interventions. Using the RoB 2 tool, we assessed bias and visualized results with Robvis. Our primary outcome was pain intensity, with secondary outcomes including disability, new fractures, and cement leakage. Results were synthesized using Stata/MP.
RESULTS
Thirty-four RCTs from 10 countries, totaling 4,384 patients, were analyzed. Shortterm VAS indicated kyphoplasty with facet joint injection (KIJ) as the top treatment at 87.7%, while unipedicular kyphoplasty (UKP) led to long-term at 74.9%. Short-term ODI favored vertebroplasty with facet joint injection (VIJ) at 98.4%, with kyphoplasty (KP) leading longterm at 66.0%. All surgical techniques were superior to conservative treatment. Vertebral augmentation devices reported the fewest new fractures and curved vertebroplasty had the least cement leakage. SUCRA (surface under the cumulative ranking) analyses suggested UKP and VIJ as top choices for postoperative pain relief, with VIJ excelling in postoperative disability improvement.
CONCLUSION
Our analysis evaluates 12 OVCF interventions, underscoring KIJ for short-term pain relief and VIJ and UKP for long-term efficacy. Notably, VIJ stands out in disability outcomes, emphasizing the need for comprehensive OVCF management.
PubMed: 38171285
DOI: 10.14245/ns.2346996.498 -
Joint Diseases and Related Surgery Jan 2024The study aimed to compare the efficacy and safety of percutaneous kyphoplasty (PKP) and vertebral body stenting (VBS) in the treatment of osteoporotic vertebral... (Meta-Analysis)
Meta-Analysis
Comparison of clinical and radiological outcomes of vertebral body stenting versus percutaneous kyphoplasty for the treatment of osteoporotic vertebral compression fracture: A systematic review and meta-analysis.
OBJECTIVES
The study aimed to compare the efficacy and safety of percutaneous kyphoplasty (PKP) and vertebral body stenting (VBS) in the treatment of osteoporotic vertebral compression fractures (OVCFs) and evaluate the clinical efficacy, Cobb angle correction, and cement leakage associated with both methods for OVCFs.
PATIENTS AND METHODS
A systematic search was conducted in PubMed, EMBASE, Cochrane Library, Medline, China National Knowledge, and Wanfang Data for clinical studies comparing VBS with PKP for OVCF up to May 2023. The meta-analysis was performed using Review Manager 5.3, with a focus on evaluating clinical and radiologic outcomes.
RESULTS
A total of eight eligible clinical studies were included in this meta-analysis. In terms of clinical outcomes, VBS was found to have a longer surgical time compared to PKP (standard mean difference [SMD]=1.06 min; 95% confidence interval [CI]: 0.20, 1.92; p=0.02). However, VBS demonstrated comparable blood loss to PKP (SMD =0.00 mL; 95% CI: -0.45, 0.45; p=0.99). Additionally, VBS showed slight superiority in alleviating back pain as measured by the Visual Analog Scale (VAS) (SMD=-0.38; 95% CI: -0.63, -0.12; p=0.004), as well as in improving functional disability based on the Oswestry Disability Index (ODI) (SMD= -0.28; 95% CI: -0.54, -0.03; p=0.03). Radiographically, VBS achieved better Cobb angle correction compared to PKP (SMD= -1.00; 95% CI: -1.48, -0.51; p<0.0001), while there was no significant difference in cement leakage between VBS and PKP (odds ratio=0.81; 95% CI: 0.21, 3.14; p=0.76).
CONCLUSION
The findings suggest that VBS has a comparable clinical outcome to PKP based on operation time, intraoperative blood loss, VAS, and ODI. Furthermore, VBS showed slightly better maintenance of Cobb angle correction, whereas VBS did not demonstrate a significant advantage over PKP in terms of cement leakage.
Topics: Humans; Kyphoplasty; Fractures, Compression; Spinal Fractures; Vertebral Body; Osteoporotic Fractures; Bone Cements
PubMed: 38108184
DOI: 10.52312/jdrs.2023.1356 -
European Spine Journal : Official... Apr 2024Vertebral augmentation, such as vertebroplasty (VP) or kyphoplasty (KP), has been utilized for decades to treat OVCFs; however, the precise impact of this procedure on... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Vertebral augmentation, such as vertebroplasty (VP) or kyphoplasty (KP), has been utilized for decades to treat OVCFs; however, the precise impact of this procedure on reducing mortality risk remains a topic of controversy. This study aimed to explore the potential protective effects of vertebral augmentation on mortality in patients with osteoporotic vertebral compression fractures (OVCFs) using a large-scale meta-analysis.
MATERIALS AND METHODS
Cochrane Library, Embase, MEDLINE, PubMed and Web of Science databases were employed for literature exploration until May 2023. The hazard ratios (HRs) and 95% confidence intervals (CIs) were utilized as a summary statistic via random-effect models. Statistical analysis was executed using Review Manager 5.3 software.
RESULTS
After rigorous screening, a total of five studies with substantial sample sizes were included in the quantitative meta-analysis. The total number of participants included in the study was an 2,421,178, comprising of 42,934 cases of vertebral augmentation and 1,991,244 instances of non-operative management. The surgical intervention was found to be significantly associated with an 18% reduction in the risk of mortality (HR 0.82; 95% CI 0.78, 0.85). Subgroup analysis revealed a remarkable 71% reduction in mortality risk following surgical intervention during short-term follow-up (HR 0.29; 95% CI 0.26, 0.32). Furthermore, KP exhibited a superior and more credible decrease in the risk of mortality when compared to VP treatment.
CONCLUSIONS
Based on a comprehensive analysis of large samples, vertebral augmentation has been shown to significantly reduce the mortality risk associated with OVCFs, particularly in the early stages following fractures. Furthermore, it has been demonstrated that KP is more reliable and effective than VP in terms of mitigating mortality risk.
Topics: Humans; Kyphoplasty; Fractures, Compression; Spinal Fractures; Osteoporotic Fractures; Vertebroplasty; Treatment Outcome
PubMed: 38062266
DOI: 10.1007/s00586-023-08032-5 -
European Spine Journal : Official... Apr 2024Osteoporotic vertebral compression fractures affect a large number of elderly people and cause significant issues with pain and mobility. Percutaneous vertebroplasty... (Review)
Review
BACKGROUND
Osteoporotic vertebral compression fractures affect a large number of elderly people and cause significant issues with pain and mobility. Percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) are employed to treat those who remain symptomatic, with comparable clinical outcomes. Although PVP is faster and less expensive, concerns around cement-leakage complications make PKP perceptively safer.
METHODS
By means of systematic review, we sought to ascertain whether PVP did carry a higher risk of cement-leakage and associated symptomatic complications (neural compromise, pulmonary embolism and need for emergency decompression surgery).
RESULTS
Our search of 138 articles returned six studies after shortlisting and manual review: three randomised-controlled trials, and three retrospective comparative studies which met our criteria and directly compared cement-leakage rates and complications between the two treatments. 532 PVPs and 493 PKPs recorded 213 (39.3%) and 143 (28.9%) leaks, respectively (p < 0.0005). Of these, no leaks resulted in any of the aforementioned leak-related complications. No meta-analysis was performed due to heterogeneity of the data.
CONCLUSIONS
We therefore concluded that whilst PVP does result in more cement leaks, this does not appear to be clinically significant. Further studies would add weight to this conclusion, and cost-effectiveness should be assessed to restore confidence in PVP.
LEVEL OF EVIDENCE
Level III Evidence.
Topics: Humans; Aged; Kyphoplasty; Fractures, Compression; Retrospective Studies; Clinical Relevance; Spinal Fractures; Osteoporotic Fractures; Treatment Outcome; Vertebroplasty; Bone Cements
PubMed: 37999769
DOI: 10.1007/s00586-023-08026-3 -
Medicine Nov 2023To investigate the effect of Vertebral augmentation (VA) in the treatment of single-level osteoporotic vertebral compression fractures (OVCFs) on new vertebral fractures. (Meta-Analysis)
Meta-Analysis
The risk of new vertebral fracture after percutaneous vertebral augmentation in patients suffering from single-level osteoporotic vertebral compression fractures: A meta-analysis and systematic review.
BACKGROUND
To investigate the effect of Vertebral augmentation (VA) in the treatment of single-level osteoporotic vertebral compression fractures (OVCFs) on new vertebral fractures.
METHODS
Electronic databases Pubmed, Embase, and the Cochrane Central Register of Controlled Trials were searched from database creation to 5 September 2022. Eligible studies had to use VA as an intervention and conservative treatment as a control group. Studies had to explicitly report whether new vertebral fractures occurred during follow-up. Data were extracted by multiple investigators. Data were pooled using random or fixed effects models depending on the degree of heterogeneity.
RESULTS
Of the 682 articles screened, 7 met the inclusion criteria and were included in the analysis, giving a total of 1240 patients. Meta-analysis showed that VA (OR = 2.10, 95% CI: 1.35-3.28, P = .001) increased the risk of new postoperative vertebral fractures compared with conservative treatment. Subgroup analyses showed that the risk was greater in the group with a follow-up time greater than 1 year (OR = 2.57, 95% CI: 1.06-6.26, P = .001). Compared with conservative treatment, VA (OR = 2.17, 95% CI: 1.23-3.82, P = .007) increased the risk of postoperative adjacent vertebral fracture.
CONCLUSION SUBSECTIONS
VA is associated with an increased risk of new vertebral fractures and adjacent vertebral fractures following single-level OVCFs. With longer follow-ups, new vertebral fractures may be more significant. Clinical surgeons should pay attention to long-term postoperative complications and choose treatment carefully.
Topics: Humans; Spinal Fractures; Fractures, Compression; Kyphoplasty; Vertebroplasty; Osteoporotic Fractures; Treatment Outcome
PubMed: 37986316
DOI: 10.1097/MD.0000000000035749