Comparative Efficacy of Surgical Interventions for Osteoporotic Vertebral Compression Fractures: A Systematic Review and Network Meta-analysis

Yanting Liu; Jin Liu; Siravich Suvithayasiri; Inbo Han; Jin-Sung Kim

doi:10.14245/ns.2346996.498

Comparative Efficacy of Surgical Interventions for Osteoporotic Vertebral Compression Fractures: A Systematic Review and Network Meta-analysis

Neurospine. 2023 Dec;20(4):1142-1158. doi: 10.14245/ns.2346996.498. Epub 2023 Dec 31.

Authors

Yanting Liu¹, Jin Liu², Siravich Suvithayasiri^{3

4}, Inbo Han⁵, Jin-Sung Kim¹

Affiliations

¹ Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
² Department of Orthopedics, Second Affiliated Hospital of Jilin University, Changchun, China.
³ Department of Orthopedics, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand.
⁴ Bone and Joint Excellence Center, Thonburi Hospital, Bangkok, Thailand.
⁵ Department of Neurosurgery, CHA University School of Medicine, CHA Bundang Medical Center, Seongnam, Korea.

Abstract

Objective: We aimed to comprehensively compare surgical methods for osteoporotic vertebral compression fracture (OVCF) using systematic review and network meta-analysis to understand their effectiveness and outcomes, as current research provides limited overviews.

Methods: We followed PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines, preregistering our protocol with PROSPERO. We analyzed Englishpublished randomized controlled trials (RCTs) on adults with OVCFs that evaluated pain intensity or functionality using tools like visual analogue scale (VAS) or Oswestry Disability Index (ODI). Exclusions included non-RCTs, malignancy-related fractures, and certain interventions. Using the RoB 2 tool, we assessed bias and visualized results with Robvis. Our primary outcome was pain intensity, with secondary outcomes including disability, new fractures, and cement leakage. Results were synthesized using Stata/MP.

Results: Thirty-four RCTs from 10 countries, totaling 4,384 patients, were analyzed. Shortterm VAS indicated kyphoplasty with facet joint injection (KIJ) as the top treatment at 87.7%, while unipedicular kyphoplasty (UKP) led to long-term at 74.9%. Short-term ODI favored vertebroplasty with facet joint injection (VIJ) at 98.4%, with kyphoplasty (KP) leading longterm at 66.0%. All surgical techniques were superior to conservative treatment. Vertebral augmentation devices reported the fewest new fractures and curved vertebroplasty had the least cement leakage. SUCRA (surface under the cumulative ranking) analyses suggested UKP and VIJ as top choices for postoperative pain relief, with VIJ excelling in postoperative disability improvement.

Conclusion: Our analysis evaluates 12 OVCF interventions, underscoring KIJ for short-term pain relief and VIJ and UKP for long-term efficacy. Notably, VIJ stands out in disability outcomes, emphasizing the need for comprehensive OVCF management.

Keywords: Kyphoplasty; Network meta-analysis; Osteoporotic vertebral compression fractures; Systematic review; Vertebroplasty.