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Advantages of unilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures—a systematic review and meta-analysis

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Abstract

Summary

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.

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Data Availability

Summary data can be obtained from the corresponding or first author upon reasonable request.

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Funding

The Ningxia Natural Science Foundation (2023AAC03543), Central Government Guides Local Science and Technology Development Fund Projects(2022FRD05038).

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Authors and Affiliations

  1. Department of Spinal Orthopedics, General Hospital of Ningxia Medical University, Yinchuan, China

    Dong-hui Cao & Hai-feng Yuan

  2. Ningxia Medical University, Yinchuan, China

    Dong-hui Cao, Wen-bo Gu, Hong-yang Zhao & Jin-long Hu

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Contributions

D.C.: study concept and design, literature screening, and desk review. W.G.: initial writing and revision of manuscript. H.Z.: literature screening, data extraction, statistical analysis, and revision of the manuscript. J.H.: critical revision of included studies and statistical support. H.Y.: primary writing, revision of the manuscript, study concept and design, statistical support, and critical revision of the manuscript. All authors have made substantive contributions to this study and manuscript, and all have reviewed the final paper before its submission.

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Correspondence to Hai-feng Yuan.

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Cao, Dh., Gu, Wb., Zhao, Hy. et al. Advantages of unilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures—a systematic review and meta-analysis. Arch Osteoporos 19, 38 (2024). https://doi.org/10.1007/s11657-024-01400-8

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