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Zeitschrift Fur Orthopadie Und... Dec 2023To summarize the literature and compare the advantages and disadvantages of the unilateral transverse process-pedicle approach (UTPA) and conventional transpedicular... (Meta-Analysis)
Meta-Analysis
PURPOSE
To summarize the literature and compare the advantages and disadvantages of the unilateral transverse process-pedicle approach (UTPA) and conventional transpedicular approach (CTPA) vertebral augmentation in the treatment of osteoporotic vertebral compression fractures (OVCF).
METHODS
A single researcher performed a systematic literature review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Online scientific databases were searched in September 2021 for English- and Chinese-language publications. A series of comparative studies were included, with UTPA as the main intervention and CTPA as the comparison indicator. A meta-analysis was performed for studies that reported clinical outcome indicators. The χ was used to study heterogeneity between trials, and the I statistic was calculated to estimate variation across studies.
RESULTS
A total of eight studies were included for meta-analysis, all of which were observational studies with mixed bias risk. There were 613 subjects in the UTPA group and 488 subjects in the CTPA group. The results of the meta-analysis showed that there was no difference between the UTPA group and the CTPA group in terms of visual analogue scale scores (p = 0.31), Oswestry Disability Index scores (p = 0.50), correction of kyphosis angle (p = 0.65), and the amount of bone cement (p = 0.13), but the UTPA group had a shorter operative time (p < 0.001), bone cement leakage rates (p = 0.02), and fluoroscopy times than the CTPA group (p < 0.001). Partial analysis results had a high risk of bias, and the most common source of bias was that there was high heterogeneity between studies, and the sensitivity can only be reduced by a random effect model, and some studies (four items) did not clearly describe the confounders that they controlled.
CONCLUSION
The limited evidence obtained in this study proves that the new puncture method does not have more advantages than the traditional technique, so it is no longer meaningful to continue to obsess over the impact of the puncture method on surgical outcome.
Topics: Humans; Kyphoplasty; Spinal Fractures; Fractures, Compression; Bone Cements; Spine; Vertebroplasty; Osteoporotic Fractures; Treatment Outcome; Retrospective Studies
PubMed: 35378564
DOI: 10.1055/a-1785-5698 -
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 -
Pain Physician 2013Osteoporotic vertebral compression fractures (OVCFs) are the most common osteoporotic fractures. Pain is the main symptom. Percutaneous vertebroplasty (PVP) is a... (Comparative Study)
Comparative Study Meta-Analysis
Comparing pain reduction following vertebroplasty and conservative treatment for osteoporotic vertebral compression fractures: a meta-analysis of randomized controlled trials.
BACKGROUND
Osteoporotic vertebral compression fractures (OVCFs) are the most common osteoporotic fractures. Pain is the main symptom. Percutaneous vertebroplasty (PVP) is a therapeutic procedure performed to reduce pain in vertebral compression fractures. Numerous case series and several small, non-blinded, non-randomized controlled studies have suggested that vertebroplasty is an effective means of relieving pain from osteoporotic fractures. However, a recent pooled analysis from 2 multicenter randomized controlled trials concluded that the improvement in pain afforded by PVP was similar to placebo.
OBJECTIVE
To compare the amount of pain reduction measured using the visual analog scale when OVCF is treated with vertebroplasty or conservatively, and assess the clinical utility of PVP.
DESIGN
A meta-analysis and systematic review of randomized controlled trials was performed comparing pain reduction following vertebroplasty and conservative treatment.
LIMITATIONS
There were few data sources from which to extract abstracted data or published studies. There were only 5 randomized controlled trials that met our criteria. The conservative treatments used as comparators in these trials were different.
METHODS
A search of MEDLINE from January 1980 to July 2012 using PubMed, the Cochrane Database of Systematic Reviews and Controlled Trials, CINAHL, and EMBASE. Relevant reports were examined by 2 independent reviewers and the references from these reports were searched for additional trials, using the criteria established in the QUOROM statement.
RESULTS
Pooled results from 5 randomized controlled trials are shown. There was no difference in pain relief in the PVP group at 2 weeks and one month when compared with the conservatively managed group. Pain relief in the PVP group was greater than that of the conservative group at 3 months, 6 months, and 12 months. However, after subgroup analysis, pain scores were similar between the PVP group and the sham injection group from 2 weeks to 6 months. Compared with non-operative therapy, PVP reduced pain at all times studied.
CONCLUSION
PVP has some value for relieving pain; however, the possibility of a placebo effect should be considered. PVP has gained acceptance as a complementary treatment when conservative management has failed before its benefits have been fully understood. More large scale, double blinded, controlled trials are necessary in order to quantify the pain relief afforded by PVP more precisely.
Topics: Adult; Aged; Female; Fractures, Compression; Humans; Male; Middle Aged; Osteoporotic Fractures; Pain; Pain Measurement; Pain, Postoperative; Randomized Controlled Trials as Topic; Spinal Fractures; Treatment Outcome; Vertebroplasty
PubMed: 24077192
DOI: No ID Found -
Pain Physician Jan 2019There have been many meta-analyses and systematic reviews that have discussed the differences between unilateral and bilateral balloon kyphoplasty. However, their...
BACKGROUND
There have been many meta-analyses and systematic reviews that have discussed the differences between unilateral and bilateral balloon kyphoplasty. However, their conclusions regarding the efficacy and safety of bilateral balloon kyphoplasty in the treatment of osteoporotic vertebral compression fractures (OVCFs) are discordant.
OBJECTIVE
We attempted to select the best evidence review to determine the differences between unilateral and bilateral balloon kyphoplasty, and we wanted to determine the best treatment approach for OVCFs.
STUDY DESIGN
A systematic review of overlapping meta-analyses.
SETTING
The electronic databases of PubMed, Embase and The Cochrane Library were searched. The search extended through Sept. 30, 2017. Moreover, we manually searched the last 10 years of conference reports and papers from the Peking University Health Science Library and consulted 2 experts in the field for any additional relevant information.
METHODS
We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Statement and used "A Measurement Tool to Assess Systematic Reviews" (AMTASR) and the Oxford Levels of Evidence to assess the methodological quality of the studies. We applied the Jadad decision algorithm to select the best evidence review.
RESULTS
Seven meta-analyses were included in this systematic review. The AMTASR scores of the studies ranged from 4 to 9, with an average of 6. Finally, Sun H et al was shown to represent the best evidence study. Sun H et al proposed that the unilateral kyphoplasty required less surgical time and consumed less cement, reduced cement leakage, and improved short-term general health compared with that of bilateral kyphoplasty.
LIMITATIONS
The AMTASR scores indicated that some of the included studies were of low quality. In addition, not all of the studies used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) level. When used, the GRADE level indicated that most of the results consisted of studies of low quality.
CONCLUSIONS
Unilateral kyphoplasty reduces the operative time, cement volume, and cement leakage rate compared with bilateral kyphoplasty. Therefore, we conclude that unilateral kyphoplasty is more advantageous, effective and safe, compared to bilateral kyphoplasty for the treatment of OVCFs.
KEY WORDS
Osteoporotic vertebral compression fracture, kyphoplasty, unilateral, bilateral, unipedicular, bipedicular, systematic review.
Topics: Fractures, Compression; Humans; Kyphoplasty; Meta-Analysis as Topic; Osteoporotic Fractures; Spinal Fractures; Treatment Outcome
PubMed: 30700065
DOI: No ID Found -
International Journal of Surgery... Apr 2017To date, there has been ongoing debate over whether intravertebral vacuum cleft (IVC) has the effect of therapeutic efficacy in percutaneous vertebral augmentation (PVA)... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
To date, there has been ongoing debate over whether intravertebral vacuum cleft (IVC) has the effect of therapeutic efficacy in percutaneous vertebral augmentation (PVA) for the treatment of osteoporotic vertebral compression fractures (OVCFs).
OBJECTIVE
The aim of this meta-analysis was to calculate a pooled estimate of the IVCs on the effect of therapeutic efficacy of PVA for the treatment of OVCFs.
METHODS
A systematic electronic literature search was performed using the following databases: PubMed, Embase and Cochrane Library; the databases were searched from the earliest available records up to June 2016. Pooled risk ratio (RR) or a mean difference (MD) with 95% confidence interval (CI) was calculated using random- or fixed-effects models. The RevMan 5.2 was used to analyze the data.
RESULTS
In the immediate postoperative period, pooled results showed that vertebral height and VAS scores of the IVC patients were significantly lower than those of the non-IVC patients. However, pooled results showed there was no significant difference in kyphotic angle and ODI indices between the two groups. At final follow-up period, significant difference was observed in all the radiological and clinical parameters for the IVC patients with compared to the non-IVC patients in our pooled results. Pooled results showed significant difference with respect to the rate of cement leakage between the two groups.
CONCLUSION
The IVCs had an important effect of therapeutic efficacy in PVA for the treatment OVCFs. Therefore, we strongly recommend its strict observation and follow-up for the IVCs patients.
Topics: Aged; Bone Cements; Female; Fractures, Compression; Humans; Male; Middle Aged; Osteoporotic Fractures; Postoperative Period; Radiography; Spinal Fractures; Treatment Outcome; Vacuum; Vertebroplasty
PubMed: 28216390
DOI: 10.1016/j.ijsu.2017.02.019 -
Pain Physician May 2018An increasing number of studies have been conducted to apply unilateral balloon kyphoplasty in the treatment of ostroporotic vertebral compression fractures (OVCFs).... (Meta-Analysis)
Meta-Analysis
BACKGROUND
An increasing number of studies have been conducted to apply unilateral balloon kyphoplasty in the treatment of ostroporotic vertebral compression fractures (OVCFs). However, the efficacy and safety of unilateral kyphoplasty and whether a unilateral or a bilateral approach is superior is controversial.
OBJECTIVES
The purpose of this study was to evaluate the role of unilateral balloon kyphoplasty and use meta-analysis to compare the efficacy and safety of unilateral and bilateral kyphoplasty in patients with OVCFs.
STUDY DESIGN
A systematic literature search was conducted from 1970 to April 2017 using Medline database and the Cochrane Central Register of Controlled Trials. Articles were limited to those published in English. Randomized controlled trials and nonrandomized comparative studies were also included.
SETTING
The following search terms were used: "osteoporotic vertebral compression fractures," or "OVCF," and "unilateral kyphoplasty," or "unipedicular approach," or "single balloon kyphoplasty," or "one balloon kyphoplasty." A comprehensive search of reference lists of retrieved articles and previous published reviews was also performed to ensure inclusion of all possible studies.
METHODS
All potential articles were independently reviewed by 2 investigators for inclusion into the final analysis. MINORS score was used for nonrandomized studies, and Detsky quality index was applied for prospective randomized controlled trials. Systematic review and meta-analysis was performed for the included studies.
RESULTS
After unilateral balloon kyphoplasty the mean postoperative visual analog score (VAS) was from 1.74 to 4.77, mean postoperative kyphotic angle was from 5.9º to 11.22º, and complications involving cement leaks was from 6.8 to 21.9% or adjacent level fractures was from 0 to 5.6%). Unilateral kyphoplasty had significantly lower operative time, and less bone cement volume; however, the postoperative VAS, Oswestry Disability Index (ODI), vertebral height restoration rate, and cement leakage and adjacent vertebral fracture rate, were similar to bilateral kyphoplasty.
LIMITATIONS
Only 6 randomized controlled trials and 3 retrospective comparative studies were selected for analysis. Heterogeneity was detected among the studies when we pooled the outcomes.
CONCLUSIONS
Based on the available evidence, the clinical and radiological results of unilateral balloon kyphoplasty were as good as those of bilateral balloon kyphoplasty for the treatment of OVCFs. And unilateral kyphoplasty had advantages in terms of operation time, radiation exposure, and cost.
KEY WORDS
Unilateral balloon kyphoplasty, bilateral balloon kyphoplasty, osteoporotic vertebral compression fractures, complications of balloon kyphoplasty, meta-analysis.
Topics: Aged; Female; Fractures, Compression; Humans; Kyphoplasty; Osteoporotic Fractures; Prospective Studies; Retrospective Studies; Spinal Fractures; Treatment Outcome
PubMed: 29871365
DOI: No ID Found -
Medicine Apr 2021The aim of this study is to investigate the clinical efficacy of zoledronic acid (ZOL) in the treatment and prevention of osteoporotic vertebral compression fractures... (Meta-Analysis)
Meta-Analysis
Clinical efficacy of zoledronic acid combined with percutaneous kyphoplasty in the prevention and treatment of osteoporotic vertebral compression fracture: A systematic review and meta-analysis.
OBJECTIVE:
The aim of this study is to investigate the clinical efficacy of zoledronic acid (ZOL) in the treatment and prevention of osteoporotic vertebral compression fractures (OVCF) after percutaneous kyphoplasty (PKP) for elderly patients.
METHODS:
The PubMed, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang, VIP, and Embase were investigated through June 2020. All randomized controlled trials (RCT) involving ZOL injections for OVCF were enrolled. Outcome indicators included the bone mineral density (BMD), Visual Analog Scale (VAS), recompression vertebral fracture (RVF), Oswestry Disability Index (ODI), and bone metabolism (Procollagen type I N-terminal propeptide [PINP] and βcross-linked C-telopeptide of type I collagen [β-CTX]), bone cement leakage. Review Manager 5.3 was used to analyze these indicators.
RESULTS:
In this study, (1).. Eight studies had met the eligibility criteria, a total of 578 participants were involved (285 and 293 in the experimental (ZOL) group and control [no ZOL] group, respectively). (2).. The BMD scores of patients with OVCF in the experimental group were significantly higher than that in the control group ( < .05). The VAS scores were significantly different between the 2 groups at the 6, 12 months follow-up ( < .05). After PKP operation, ZOL injections reduced the rate of RVF ( < .05). In the comparison of ODI scores, the experimental group improved compared with the control group ( < .05). Respectively, the bone metabolism of patients with OVCF after ZOL was better than that of patients in control group ( < .05).
CONCLUSION:
Zoledronic acid had a significant effect on the treatment and prevention of OVCF in elderly osteoporotic patients after PKP. Due to the limited quality and data, more high-quality studies are needed to confirm the results of this meta-analysis.
Topics: Bone Density Conservation Agents; Humans; Kyphoplasty; Osteoporotic Fractures; Spinal Fractures; Zoledronic Acid
PubMed: 33787604
DOI: 10.1097/MD.0000000000025215 -
Pain Physician May 2021Percutaneous kyphoplasty (PKP) has been reported to provide a favorable analgesic effect for pain caused by osteoporotic vertebral compression fractures (OVCFs)....
BACKGROUND
Percutaneous kyphoplasty (PKP) has been reported to provide a favorable analgesic effect for pain caused by osteoporotic vertebral compression fractures (OVCFs). However, a systematic review demonstrated that pain relief was only reported for approximately 86% of kyphoplasty treatments.
OBJECTIVES
To explore whether an additional facet joint block (FJB) can minimize pain and improve the clinical outcome of PKP in patients with acute OVCFs.
STUDY DESIGN
Prospective study.
SETTING
All data were from Honghui Hospital in Xi'an.
METHODS
According to the inclusion and exclusion criteria, 194 patients were eventually included in our study; they were randomly divided into 2 groups of 97 patients each and treated with either PKP + FJB or PKP alone. Follow-up consultations were scheduled 1 day, 3 days, 1 week, 1 month, 3 months, and 1 year postoperatively; the demographic characteristics, related surgical information, and complications observed within both groups were recorded. The clinical evaluation parameters included the intraoperative satisfaction score, the Visual Analog Scale (VAS) score, and the Oswestry Disability Index (ODI).
RESULTS
A total of 171 patients (61 men and 110 women; age range: 62-85 years) completed the full postoperative follow-up schedule, with 83 patients in the PKP + FJB group and 88 in the PKP group. No significant differences were observed in the genders, ages, preoperative bone mineral density, surgical levels, or volume of cement injected between the 2 groups (P > 0.05, respectively). The average duration of the surgeries in the PKP + FJB group was slightly longer than that in the PKP group (35.5 ± 4.8 min vs. 31.8 ± 4.3 min; P = 0.038), and in terms of the clinical outcomes, the average intraoperative satisfaction score was significantly higher in the PKP + FJB group (8.6 ± 1.1 vs. 6.3 ± 1.3; P < 0.001). Compared with the preoperative data, significant improvements in the VAS scores of back pain and ODI were observed at each follow-up interval (P < 0.05, respectively). These scores were significantly higher in the PKP + FJB group than in the PKP group; however, this was only observed within the first month after the procedure.
LIMITATIONS
A single-center noncontrol study.
CONCLUSIONS
The addition of an FJB (which in our study involved a unique combination of ropivacaine, prednisolone, and vitamin B12) improved the short-term clinical outcome of PKP for acute OVCFs. The local anti-inflammatory and analgesic effects on the facet joints resulted in higher intraoperative satisfaction and lower VAS and ODI scores for the first postoperative month when compared with the PKP group.
Topics: Aged; Aged, 80 and over; Bone Cements; Female; Fractures, Compression; Humans; Kyphoplasty; Male; Middle Aged; Osteoporotic Fractures; Prospective Studies; Randomized Controlled Trials as Topic; Retrospective Studies; Spinal Fractures; Treatment Outcome; Zygapophyseal Joint
PubMed: 33988948
DOI: No ID Found -
Journal of Orthopaedic Surgery and... Sep 2020A systematic review and meta-analysis to assess the pros and cons of percutaneous vertebroplasty (PVP) versus kyphoplasty (PKP) for osteoporotic vertebral compression... (Meta-Analysis)
Meta-Analysis
BACKGROUND
A systematic review and meta-analysis to assess the pros and cons of percutaneous vertebroplasty (PVP) versus kyphoplasty (PKP) for osteoporotic vertebral compression fractures (OVCFs) with intravertebral cleft (IVC) including all available evidence from controlled trials.
METHODS
Databases including Pubmed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang Data were searched to identify relevant studies comparing PVP and PKP for OVCFs with IVC. The outcomes mainly included visual analog scale (VAS), Oswestry Disability Index (ODI), local kyphotic angle (LKA), rate of vertebral height (VH%), and adverse events.
RESULTS
Nine studies enrolling 688 patients were eligible for meta-analysis. The results indicated no significant differences between the two groups in the short-and long-term VAS, ODI, LKA, or VH% (P > 0.05). Compared with PVP, PKP was associated with significantly longer operation time (P < 0.05), higher cost (P > 0.05), and more injected cement volume (P < 0.05). In terms of adverse events, PKP has a lower risk of cement leakage (P < 0.05), while with no significant difference in adjacent-level fracture rates (P > 0.05).
CONCLUSION
The two procedures have similar short- and long-term pain relief, functional recovery, local kyphosis correction, and vertebral height maintenance in OVCFs with IVC. PKP is superior to PVP for the injected cement volume, and lower cement leakage rate, however, with longer operation time, more fluoroscopy times, and higher cost. Further randomized controlled trials (RCTs) should be conducted to confirm these results.
Topics: Bone Cements; Endoleak; Female; Fluoroscopy; Fractures, Compression; Humans; Kyphoplasty; Male; Minimally Invasive Surgical Procedures; Operative Time; Osteoporotic Fractures; Pain Management; Pain Measurement; Recovery of Function; Spinal Fractures; Treatment Outcome; Vertebroplasty
PubMed: 32912267
DOI: 10.1186/s13018-020-01938-6 -
Annals of Palliative Medicine Nov 2021Percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) are common vertebral augmentation (VA) procedures for the treatment of osteoporotic vertebral... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) are common vertebral augmentation (VA) procedures for the treatment of osteoporotic vertebral compression fractures (OVCF), each with their own advantages and disadvantages. In recent years, the development of new implant-assisted technologies has provided a breakthrough in VA. This study systematically evaluated and meta-analyzed the reports on new implant-assisted VA techniques in recent years, so as to provide evidence for clinical diagnosis and treatment.
METHODS
The PubMed, Embase, Ovid, and SpringerLink databases were searched for randomized controlled studies on VA in the treatment of OVCF. In this study, patients in the experimental group were treated with PVP using the new implant-assisted VA technique, while patients in the control group were treated with PKP. Bias assessment was conducted using the tool integrated with the Revman 5.4 software, and meta-analysis was carried out to compare the mid-term postoperative pain relief, functional status, quality of life, and cement extravasation between the two groups (each presented with a forest plot).
RESULTS
Eight articles were finally included in the selection, involving a total of 1,027 patients. PVP surgery using the new implant-assisted VA technique was superior to PKP surgery in relieving postoperative pain [mean difference (MD) =-3.77, 95% CI: -5.63, -1.92, P<0.0001] and improving the postoperative Oswestry Disability Index (ODI) score (MD =-1.59, 95% CI: -3.01, -0.16, P=0.03). However, it was not significantly different from PKP surgery in improving postoperative quality of life (MD =-0.27, 95% CI: -3.55, 3.01, P=0.87), and the cement extravasation rate was significantly lower than that of PKP surgery [odd ratio (OR) =0.38, 95% CI: 0.19, 0.74, P=0.004].
DISCUSSION
The new implant-assisted VA technique can significantly relieve pain, reduce clinical symptoms, improve postoperative quality of life, and significantly reduce the problem of cement extravasation. However, this new technology is still evolving, and more high-quality randomized controlled studies on this topic are needed to provide stronger evidence.
Topics: Fractures, Compression; Humans; Pain, Postoperative; Quality of Life; Spinal Fractures; Vertebroplasty
PubMed: 34872301
DOI: 10.21037/apm-21-2834