The risk of subsequent vertebral fracture following cement vertebral augmentation and consecutive treatment osteoporotic vertebral compression fractures: a meta-analysis

English Keywords:Osteoporosis  Osteoporotic vertebral compressive fractures  Cement vertebral augmentation  Subsequent vertebral fracture

English Abstract:

  【Abstract】 Objective: A systematic review of published randomized controlled trials about cement vertebral augmentation[percutaneous vertebroplasty(PVP) / percutaneous kyphoplasty (PKP)] and conservative treatment of osteoporotic vertebral compression fracture(OVCF), had been conducted to investigate the risk of new vertebral fracture on postoperative patients undergoing vertebral augmentation, and to provide statistical evidence for medical care and scientific research. Methods: Databases including PubMed, Web of Science, Cochrane library, EMBASE Database were searched to collect randomized controlled trials(RCTs) about the safety and refracture after cement vertebral augmentation and conservative treatment in OVCF from inception to April 2018. Following the Cochrane Collaborative Web System Evaluation Method, the study rigorously evaluated the quality and reliability of the included literature and extracted relevant data from the researches including the number of fractured vertebral bodies, the level of vertebral fracture, the degree of vertebral compression, the bone mineral density and subsequent vertebral fractures. Then, a meta-analysis was conducted through Review man 5.3 software, and the data were pooled by using a fixed effect model or a random effect model to calculate the relative risk(RR)/ standardized mean difference(SMD) and 95% confidence interval(CI). Publication bias was determined by the funnel plot. Results: A total of 9 RCTs involving 853 cases of OVCF was included, in which 437 cases underwent vertebral augmentation and 416 cases underwent conservative treatment. According to Cochrane Handbook for Systematic Reviews, two literatures were high quality, five literatures were medium quality, two literatures were low quality. In Meta-analysis, there was no statistically significant difference between the two groups(P>0.05) in the incidence of new vertebral fracture[RR=1.13, 95%CI(0.85, 1.49), P=0.41] and incidence of adjacent vertebral refracture[RR=0.93, 95%CI(0.48，1.82), P=0.84]. Conclusions: Cement vertebral augmentation is minimally invasive treatment for OVCF, which does not increase the risk of new vertebral fracture after PVP/PKP. Its occurrence might be related to the natural procedure of osteoporosis.