Percutaneous kyphoplasty for osteoporotic vertebral compression fractures via unilateral versus bilateral approach: A meta-analysis

Abstract

The objective of the research was to compare the efficacy of lateral and bilateral PKP approaches for OVCFs. A comprehensive literature search was performed from the PubMed, Cochrane Library and Embase between January 2008 and May 2017. The clinical efficacy of the two approaches was evaluated by comparing perioperative outcomes (operation time, the volume of injected cement, X-ray exposure times and mean radiation dose), clinical outcomes (kyphotic angle reduction, restoration rate, visual analogue scale [VAS], Oswestry Disability Index [ODI] and SF-36), and operation-related complications (cement leakage and adjacent vertebral fracture). Data was analyzed using Review Manger 5.3.A total of 791 patients from 10 studies were included in our meta-analysis. The pooled results showed significant difference in operation time (weighted mean difference [WMD] -19.67, 95% confidence interval [CI] [-25.20 to -14.14]; P < 0.001); volume of injected cement (WMD -2.03, 95%CI [-2.63 to -1.42]; P < 0.001); mean radiation dose in patients (WMD -1.06 95CI [-1.23 to -0.90]; P < 0.001); and the rate of cement leakage (WMD 0.58 95CI [0.38-0.90]; P = 0.01) between these two approaches. However, the pooled results revealed no significant difference in X-ray exposure times, kyphotic angle reduction, restoration rate, VAS, ODI, SF-36 and adjacent vertebral fracture. Our study presented that patients with OVCFs could obtain similar satisfactory clinical results via both unilateral and bilateral PKP approaches. Considering less operation time, less cement volume, lower mean radiation dose of patients, a lower rate of cement leakage and less surgery-related costs, we suggest that a unilateral PKP approach is advantageous.

Keywords: Bilateral; Meta-analysis; Osteoporotic; Percutaneous kyphoplasty; Unilateral; Vertebral compression fractures.