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Unilateral versus bilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures: A meta-analysis

BACKGROUND: The debate on the efficacy of unilateral percutaneous kyphoplasty (UPKP) and bilateral percutaneous kyphoplasty (BPKP) for the treatment of osteoporotic vertebral compression fractures (OVCFs) is ongoing. This meta-analysis aimed to evaluate the clinical results of UPKP and BPKP in the t...

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Autores principales: Chang, Wenli, Zhang, Xinyan, Jiao, Ning, Yuwen, Peizhi, Zhu, Yanbin, Zhang, Fei, Chen, Wei
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5413259/
https://www.ncbi.nlm.nih.gov/pubmed/28445294
http://dx.doi.org/10.1097/MD.0000000000006738
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author Chang, Wenli
Zhang, Xinyan
Jiao, Ning
Yuwen, Peizhi
Zhu, Yanbin
Zhang, Fei
Chen, Wei
author_facet Chang, Wenli
Zhang, Xinyan
Jiao, Ning
Yuwen, Peizhi
Zhu, Yanbin
Zhang, Fei
Chen, Wei
author_sort Chang, Wenli
collection PubMed
description BACKGROUND: The debate on the efficacy of unilateral percutaneous kyphoplasty (UPKP) and bilateral percutaneous kyphoplasty (BPKP) for the treatment of osteoporotic vertebral compression fractures (OVCFs) is ongoing. This meta-analysis aimed to evaluate the clinical results of UPKP and BPKP in the treatment of OVCFs. METHODS: Web of Science, PubMed, Embase, and the Chinese Biomedical Database publication databases were searched using a date range of January 2008 to November 2016, for studies comparing UPKP and BPKP for the treatment of OVCFs. The clinical effectiveness was assessed by comparing perioperative outcomes (surgery time, the volume of injected cement, X-ray exposure time, and kyphotic angle reduction), clinical outcomes (visual analogue scale [VAS] for pain relief and Oswestry Disability Index [ODI] for quality of life), and surgery-related complications (cement leakage and adjacent vertebral fractures). Data were analyzed using Stata/SE11.0 software. RESULTS: Fourteen trials with 1194 patients were retrieved. The pooled results showed significant differences in surgery time (weighted mean difference [WMD] −21.44, 95% confidence interval [CI] [−23.57 to −19.30]; P < .001); volume of injected cement [WMD −1.90, 95% CI [−2.26 to −1.54); P < .001); and X-ray exposure time (WMD −13.66, 95%CI [−19.59 to −7.72]; P < .001) between UPKP and BPKP treatments. However, the pooled results showed no significant differences in kyphotic angle reduction, VAS in the short-term, VAS in the long-term, ODI, cement leakage, or adjacent vertebral fractures between the 2 surgical procedures. Following a subgroup analysis, the results based on randomized controlled trials (RCTs) indicated that there were significant differences in surgery time (WMD −24.65, 95%CI [−26.53 to −22.77]; P < .001) and the volume of injected cement (WMD −1.66, 95%CI [−1.97 to −1.36]; P < .001) between UPKP and BPKP treatment procedures, respectively. The results based on RCTs indicated that there were no significant differences, either in kyphotic angle reduction or in X-ray exposure time, between the 2 surgical procedures. CONCLUSIONS: Compared to BPKP procedures, UPKP procedures may achieve similar clinical results in the treatment of OVCFs when assessed in terms of the pain relief, improvements in life quality, and surgery-related complications. However, UPKP procedures had a shorter operation time and volume of injected cement compared with BPKP procedures. Additional high quality and multicenter RCTs are needed to provide further robust evidence.
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spelling pubmed-54132592017-05-05 Unilateral versus bilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures: A meta-analysis Chang, Wenli Zhang, Xinyan Jiao, Ning Yuwen, Peizhi Zhu, Yanbin Zhang, Fei Chen, Wei Medicine (Baltimore) 7100 BACKGROUND: The debate on the efficacy of unilateral percutaneous kyphoplasty (UPKP) and bilateral percutaneous kyphoplasty (BPKP) for the treatment of osteoporotic vertebral compression fractures (OVCFs) is ongoing. This meta-analysis aimed to evaluate the clinical results of UPKP and BPKP in the treatment of OVCFs. METHODS: Web of Science, PubMed, Embase, and the Chinese Biomedical Database publication databases were searched using a date range of January 2008 to November 2016, for studies comparing UPKP and BPKP for the treatment of OVCFs. The clinical effectiveness was assessed by comparing perioperative outcomes (surgery time, the volume of injected cement, X-ray exposure time, and kyphotic angle reduction), clinical outcomes (visual analogue scale [VAS] for pain relief and Oswestry Disability Index [ODI] for quality of life), and surgery-related complications (cement leakage and adjacent vertebral fractures). Data were analyzed using Stata/SE11.0 software. RESULTS: Fourteen trials with 1194 patients were retrieved. The pooled results showed significant differences in surgery time (weighted mean difference [WMD] −21.44, 95% confidence interval [CI] [−23.57 to −19.30]; P < .001); volume of injected cement [WMD −1.90, 95% CI [−2.26 to −1.54); P < .001); and X-ray exposure time (WMD −13.66, 95%CI [−19.59 to −7.72]; P < .001) between UPKP and BPKP treatments. However, the pooled results showed no significant differences in kyphotic angle reduction, VAS in the short-term, VAS in the long-term, ODI, cement leakage, or adjacent vertebral fractures between the 2 surgical procedures. Following a subgroup analysis, the results based on randomized controlled trials (RCTs) indicated that there were significant differences in surgery time (WMD −24.65, 95%CI [−26.53 to −22.77]; P < .001) and the volume of injected cement (WMD −1.66, 95%CI [−1.97 to −1.36]; P < .001) between UPKP and BPKP treatment procedures, respectively. The results based on RCTs indicated that there were no significant differences, either in kyphotic angle reduction or in X-ray exposure time, between the 2 surgical procedures. CONCLUSIONS: Compared to BPKP procedures, UPKP procedures may achieve similar clinical results in the treatment of OVCFs when assessed in terms of the pain relief, improvements in life quality, and surgery-related complications. However, UPKP procedures had a shorter operation time and volume of injected cement compared with BPKP procedures. Additional high quality and multicenter RCTs are needed to provide further robust evidence. Wolters Kluwer Health 2017-04-28 /pmc/articles/PMC5413259/ /pubmed/28445294 http://dx.doi.org/10.1097/MD.0000000000006738 Text en Copyright © 2017 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by/4.0 This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0
spellingShingle 7100
Chang, Wenli
Zhang, Xinyan
Jiao, Ning
Yuwen, Peizhi
Zhu, Yanbin
Zhang, Fei
Chen, Wei
Unilateral versus bilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures: A meta-analysis
title Unilateral versus bilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures: A meta-analysis
title_full Unilateral versus bilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures: A meta-analysis
title_fullStr Unilateral versus bilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures: A meta-analysis
title_full_unstemmed Unilateral versus bilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures: A meta-analysis
title_short Unilateral versus bilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures: A meta-analysis
title_sort unilateral versus bilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures: a meta-analysis
topic 7100
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5413259/
https://www.ncbi.nlm.nih.gov/pubmed/28445294
http://dx.doi.org/10.1097/MD.0000000000006738
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