Comparison of unilateral versus bilateral percutaneous kyphoplasty for the treatment of patients with osteoporosis vertebral compression fracture (OVCF): a systematic review and meta-analysis

• Published in: European spine journal 2016-11, Vol.25 (11), p.3439-3449
• Main Authors: Cheng, Xing, Long, Hou-Qing, Xu, Jing-Hui, Huang, Yang-Liang, Li, Fo-Bao
• Format: Article
• Language: English
• Subjects: Fractures, Compression - surgery; Humans; Kyphoplasty - adverse effects; Kyphoplasty - methods; Kyphoplasty - statistics & numerical data; Medicine; Medicine & Public Health; Neurosurgery; Operative Time; Original Article; Osteoporotic Fractures - surgery; Pain, Postoperative; Spinal Fractures - surgery; Surgical Orthopedics
• ISSN: 0940-6719; 1432-0932
• DOI: 10.1007/s00586-016-4395-6

Purpose To compare the short- and long-term clinical outcomes, operation times, restoration rate, dosage of polymethylmeth-acrylate (PMMA) injected, complications and X-rays exposure frequency between unilateral and bilateral kyphoplasty approaches for the treatment of OVCF. Study design Systematic review and meta-analysis. Methods Randomized or non-randomized controlled trials published up to April 2015 that compared the unilateral and bilateral PKP for the treatment of OVCF were acquired by a comprehensive search in the Cochrane Controlled Trial Register, PubMed, MEDLINE, EMBASE, Web of Science, OVID. Exclusion criteria were patients with neoplastic etiology (metastasis or myeloma), infection, neural compression syndrome, invasive and degenerative disease, traumatic fracture, re-operation, neurological deficits, significant scoliosis and spinal stenosis. The main end points included: operation times, the short- and long-term postoperative Visual Analogue Scale (VAS) scores, the short-term postoperative Oswestry Disability Index (ODI), restoration rate, dosage of PMMA injected, cement leakage, X-ray exposure frequency and postoperative adjacent-level fractures. Results A total of 8 studies involving 428 patients were included in the meta-analysis. The mean operative time was shorter in the unilateral groups compared with the bilateral groups [ P   0.05, WMD 0.03 (−0.34, 0.40)], the long-term postoperative VAS scores between them [ P  > 0.05, WMD 0.01 (−0.42, 0.45)] and the short-term postoperative ODI [ P  > 0.05, WMD −0.33 (−2.36, 1.69)] between the two groups. The unilateral approaches required significantly less dosage of PMMA than the bipedicular approaches did [ P   0.05, RR 0.91 (0.25, 3.26)] between the two methods. The mean X-ray exposure frequency in the unilateral groups was greater than the bilateral groups [ P