Unilateral versus bilateral percutaneous balloon kyphoplasty for osteoporotic vertebral compression fractures: A systematic review of overlapping meta-analyses

BACKGROUND: Unilateral and bilateral percutaneous balloon kyphoplasty (PKP) are 2 main approaches for the treatment of patients with osteoporotic vertebral compression fractures (OVCFs). Numerous published systematic reviews and meta-analyses evaluating the effectiveness of 2 approaches remain inconclusive. In order to propose a significant principle to make decisions for comparing clinical safety and efficacy of unilateral versus bilateral PKP for treating OVCFs patients based on the currently best available evidence, a systematic review of overlapping meta-analysis was conducted. METHODS: Three electronic databases, Pubmed/Medline, Embase2 and the Cochrance Library, were searched systematically to retrieve and identify all eligible systematic reviews and meta-analyses comparing unilateral and bilateral PKP for the treatment of patients with OVCFs. Only systematic reviews or meta-analyses with an exclusively pooled analysis of randomized controlled trials (RCTs) met the minimum eligibility criteria in this investigation. The Oxford Levels of Evidence, Jadad algorithm and Assessment of Multiple Systematic Reviews (AMSTAR) instrument were adopted for evaluation of the methodological quality for each included literature to select currently best available evidence. RESULTS: Screening determined that out of 2159, 9 meta-analyses with level II or III of evidence met the inclusion criteria in the systematic review of overlapping meta-analyses. The multiple systematic reviews scores ranged from 8 to 9 with a mean of 8.55 (median 8.5). According to the search process and selection strategies of the Jadad algorithm, a meta-analysis by Feng et al with the best available evidence (12 RCTs and an AMSTAR score of 9) demonstrated that unilateral and bilateral PKP are both nice choices for the treatment of patients with OVCFs, and no significant differences were revealed in clinical scores, radiological outcomes, and quality of life with long-term follow-up. However, compared with bilateral PKP, unilateral PKP produced a shorter surgery time, smaller dosage of cement, lower risk of cement leakage, and relieved a higher degree of intractable pain at short-term follow-up after surgery. CONCLUSION: Unilateral percutaneous balloon kyphoplasty is more advantageous and superior to bilateral percutaneous kyphoplasty, and should be considered an effective option for the treatment of patients with osteoporotic vertebral compression fractures.