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High- versus low-viscosity cement vertebroplasty and kyphoplasty for osteoporotic vertebral compression fracture: a meta-analysis

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Abstract

Background

To compare high- versus low-viscosity bone cement on the clinical outcomes and complications in patients with Osteoporotic vertebral compression fractures (OVCFs) who underwent percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP).

Methods

PubMed, Embase, and the Cochrane Library were searched for papers published from inception up to February 2021 for potentially eligible studies comparing high- versus low-viscosity cement for PVP/PKP. The outcomes were the leakage rate, visual analog scale (VAS), and Oswestry Disability Index (ODI).

Results

Eight studies (558 patients; 279 in each group) were included. The meta-analysis showed that the leakage rate was lower with high-viscosity cement than with low-viscosity cement (OR = 0.23, 95%CI 0.14–0.39, P < 0.001; I2 = 43.5%, Pheterogeneity = 0.088); similar results were observed specifically for the disk space, paravertebral space, and peripheral vein, but there were no differences regarding the epidural space and intraspinal space. The VAS was decreased more significantly with high-viscosity cement than with low-viscosity cement (WMD = − 0.21, 95%CI − 0.38, − 0.04, P = 0.015; I2 = 0.0%, Pheterogeneity = 0.565). Regarding the ODI, there was no difference between high- and low-viscosity cement (WMD = − 0.88, 95%CI − 3.06, 1.29, P = 0.426; I2 = 78.3%, Pheterogeneity < 0.001).

Conclusions

There were lower cement leakage rates in PVP/PKP with high-viscosity bone cement than low-viscosity bone cement. The two groups have similar results in ODI, but the VAS scores favor high-viscosity bone cement. Therefore, the administration of high-viscosity bone cement in PVP/ PKP could be a potential option for improving the complications of leakage in OVCFs, while the clinical efficacy of relieving pain is not certain.

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Data availability

The dataset(s) supporting the conclusions of this article is(are) included within the article (and its additional file(s).

Abbreviations

OVCFs:

Osteoporotic vertebral compression fractures

PVP:

Percutaneous vertebroplasty

PKF:

Percutaneous kyphoplasty

VAS:

Visual analog scale

ODI:

Oswestry disability index

PKP:

Percutaneous kyphoplasty

NOS:

Newcastle–Ottawa scale

RCTs:

Randomized controlled trials

SD:

Standard deviations

ORs:

Odds ratios

WMDs:

Weighted mean differences

CIs:

Confidence intervals

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Funding

The study was supported by Beijing Hospital Clinical Research 121 Project (BJ-2018-203).

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Authors and Affiliations

  1. Department of Orthopaedics, Orthopaedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dongdan DaHua Road, Beijing, 100730, China

    Qiang Wang, Changtai Sun, Liang Zhang, Lin Wang, Quan Ji, Nan Min & Zilong Yin

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  1. Qiang Wang
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  2. Changtai Sun
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  3. Liang Zhang
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  4. Lin Wang
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  5. Quan Ji
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  6. Nan Min
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  7. Zilong Yin
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Contributions

QW analyzed and interpreted the patient data regarding osteoporotic vertebral compression fracture. QW performed the statistical analysis, and was a major contributor in writing the manuscript. All authors read and approved the final manuscript.

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Correspondence to Qiang Wang.

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Wang, Q., Sun, C., Zhang, L. et al. High- versus low-viscosity cement vertebroplasty and kyphoplasty for osteoporotic vertebral compression fracture: a meta-analysis. Eur Spine J 31, 1122–1130 (2022). https://doi.org/10.1007/s00586-022-07150-w

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