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Kyphoplasty is associated with reduced mortality risk for osteoporotic vertebral compression fractures: a systematic review and meta-analysis

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Abstract

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.

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Acknowledgements

This work was supported by grants from National Nature Science Foundation of China (Grant Nos: 82072442, 82272494), the Priority Academic Program Development of Jiangsu Higher Education Institutions (PAPD).

Funding

National Nature Science Foundation of China, 82072442, Xuesong Zhu, 82272494, Xuesong Zhu, the Priority Academic Program Development of Jiangsu Higher Education Institutions (PAPD), Null, Huilin Yang

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Author notes

  1. Yijian Zhang, Jun Ge and Hao Liu contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 899 Pinghai Road, Suzhou, 215006, Jiangsu, China

    Yijian Zhang, Jun Ge, Hao Liu, Junjie Niu, Shenghao Wang, Hao Shen, Hanwen Li, Chen Qian, Zhuorun Song, Pengfei Zhu, Xuesong Zhu, Jun Zou & Huilin Yang

  2. Orthopaedic Institute, Medical College, Soochow University, Suzhou, 215007, China

    Yijian Zhang, Jun Ge, Hao Liu, Junjie Niu, Shenghao Wang, Hao Shen, Hanwen Li, Chen Qian, Zhuorun Song, Pengfei Zhu, Xuesong Zhu, Jun Zou & Huilin Yang

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  1. Yijian Zhang
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Correspondence to Xuesong Zhu, Jun Zou or Huilin Yang.

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Zhang, Y., Ge, J., Liu, H. et al. Kyphoplasty is associated with reduced mortality risk for osteoporotic vertebral compression fractures: a systematic review and meta-analysis. Eur Spine J 33, 1490–1497 (2024). https://doi.org/10.1007/s00586-023-08032-5

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