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Comparison of unilateral versus bilateral percutaneous kyphoplasty for the treatment of patients with osteoporosis vertebral compression fracture (OVCF): a systematic review and meta-analysis
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...
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| Published in: | European spine journal 2016-11, Vol.25 (11), p.3439-3449 |
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| creator | Cheng, Xing Long, Hou-Qing Xu, Jing-Hui Huang, Yang-Liang Li, Fo-Bao |
| description | 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
|
| doi_str_mv | 10.1007/s00586-016-4395-6 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1837311174</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1837311174</sourcerecordid><originalsourceid>FETCH-LOGICAL-c405t-f0fa3ed123ad3103c16eaad148d035fdb3cf37333f8245e9a6afcf73f039722a3</originalsourceid><addsrcrecordid>eNqNks1u1TAQhS0EopfCA7BBltiURcB_cRJ21RUFpErdANtorjPmuiRxsJ1WeTpeDYeUCiEhsbI1PucbzfgQ8pyz15yx6k1krKx1wbgulGzKQj8gO66kKFgjxUOyY41iha54c0KexHjNGC8bph-TE6FrrlRV7siPvR8mCC76kXpL59H1kDBAT28wxDnSw31hwmDmBCP6XP62TEc_9RDTQq0PNB2RpoCQBhzTSpoguXyN9NalI_UxoZ988NHFlZzwsCJNbh4wRpe72wAmzQHp2dWX_cWrtxRoXLJtyCBDA944vKUwdnTABAWM0C8Z9pQ8stBHfHZ3npLPF-8-7T8Ul1fvP-7PLwujWJkKyyxI7LiQ0EnOpOEaATqu6o7J0nYHaayspJS2FqrEBjRYYytpmWwqIUCekrONOwX_fcaY2sFFg32_7aPldbZzziv1H1KhdVkzWWfpy7-k134OebRfQKFk1dQ6q_imMnl_MaBtp-AGCEvLWbsGod2C0OYgtGsQ2tXz4o48Hwbs7h2_fz4LxCaI-Wn8iuGP1v-k_gRdBcM9</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1832437986</pqid></control><display><type>article</type><title>Comparison of unilateral versus bilateral percutaneous kyphoplasty for the treatment of patients with osteoporosis vertebral compression fracture (OVCF): a systematic review and meta-analysis</title><source>Springer Nature</source><creator>Cheng, Xing ; Long, Hou-Qing ; Xu, Jing-Hui ; Huang, Yang-Liang ; Li, Fo-Bao</creator><creatorcontrib>Cheng, Xing ; Long, Hou-Qing ; Xu, Jing-Hui ; Huang, Yang-Liang ; Li, Fo-Bao</creatorcontrib><description>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, weighted mean difference (WMD) −19.74 (−30.56, −8.92)]. There was no significant difference in the short-term postoperative VAS scores [
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, WMD −1.56 (−1.59, −1.16)]. The restoration rate in the bilateral groups was higher than the unilateral groups [
P
< 0.05, WMD −7.82 (−12.23, −3.41)]. There was no significant difference in the risk ratio of cement leakage [
P
> 0.05, RR 0.86 (0.36, 2.06)] and postoperative adjacent-level fractures [
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
< 0.05, WMD −5.69 (−10.67, −0.70)].
Conclusions
A definitive verdict could not be reached regarding which approach is better for the treatment of OVCF. Although unilateral PKP was associated with shorter operative time, less X- ray exposure frequency and dosage of PMMA than bilateral PKP. There was no apparent difference in the short- and long-term clinical outcomes and complications between them. However, bilateral PKP approaches were higher than unilateral PKP in term of the restoration rate. But on account of lack of some high-quality evidence, we hold that amounts of high-quality randomized controlled trials should be required and more complications should be analysed to resolve which surgical approach is better for the treatment of OVCF in the future.</description><identifier>ISSN: 0940-6719</identifier><identifier>EISSN: 1432-0932</identifier><identifier>DOI: 10.1007/s00586-016-4395-6</identifier><identifier>PMID: 26814475</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>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</subject><ispartof>European spine journal, 2016-11, Vol.25 (11), p.3439-3449</ispartof><rights>Springer-Verlag Berlin Heidelberg 2016</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c405t-f0fa3ed123ad3103c16eaad148d035fdb3cf37333f8245e9a6afcf73f039722a3</citedby><cites>FETCH-LOGICAL-c405t-f0fa3ed123ad3103c16eaad148d035fdb3cf37333f8245e9a6afcf73f039722a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26814475$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cheng, Xing</creatorcontrib><creatorcontrib>Long, Hou-Qing</creatorcontrib><creatorcontrib>Xu, Jing-Hui</creatorcontrib><creatorcontrib>Huang, Yang-Liang</creatorcontrib><creatorcontrib>Li, Fo-Bao</creatorcontrib><title>Comparison of unilateral versus bilateral percutaneous kyphoplasty for the treatment of patients with osteoporosis vertebral compression fracture (OVCF): a systematic review and meta-analysis</title><title>European spine journal</title><addtitle>Eur Spine J</addtitle><addtitle>Eur Spine J</addtitle><description>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, weighted mean difference (WMD) −19.74 (−30.56, −8.92)]. There was no significant difference in the short-term postoperative VAS scores [
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, WMD −1.56 (−1.59, −1.16)]. The restoration rate in the bilateral groups was higher than the unilateral groups [
P
< 0.05, WMD −7.82 (−12.23, −3.41)]. There was no significant difference in the risk ratio of cement leakage [
P
> 0.05, RR 0.86 (0.36, 2.06)] and postoperative adjacent-level fractures [
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
< 0.05, WMD −5.69 (−10.67, −0.70)].
Conclusions
A definitive verdict could not be reached regarding which approach is better for the treatment of OVCF. Although unilateral PKP was associated with shorter operative time, less X- ray exposure frequency and dosage of PMMA than bilateral PKP. There was no apparent difference in the short- and long-term clinical outcomes and complications between them. However, bilateral PKP approaches were higher than unilateral PKP in term of the restoration rate. But on account of lack of some high-quality evidence, we hold that amounts of high-quality randomized controlled trials should be required and more complications should be analysed to resolve which surgical approach is better for the treatment of OVCF in the future.</description><subject>Fractures, Compression - surgery</subject><subject>Humans</subject><subject>Kyphoplasty - adverse effects</subject><subject>Kyphoplasty - methods</subject><subject>Kyphoplasty - statistics & numerical data</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Neurosurgery</subject><subject>Operative Time</subject><subject>Original Article</subject><subject>Osteoporotic Fractures - surgery</subject><subject>Pain, Postoperative</subject><subject>Spinal Fractures - surgery</subject><subject>Surgical Orthopedics</subject><issn>0940-6719</issn><issn>1432-0932</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><recordid>eNqNks1u1TAQhS0EopfCA7BBltiURcB_cRJ21RUFpErdANtorjPmuiRxsJ1WeTpeDYeUCiEhsbI1PucbzfgQ8pyz15yx6k1krKx1wbgulGzKQj8gO66kKFgjxUOyY41iha54c0KexHjNGC8bph-TE6FrrlRV7siPvR8mCC76kXpL59H1kDBAT28wxDnSw31hwmDmBCP6XP62TEc_9RDTQq0PNB2RpoCQBhzTSpoguXyN9NalI_UxoZ988NHFlZzwsCJNbh4wRpe72wAmzQHp2dWX_cWrtxRoXLJtyCBDA944vKUwdnTABAWM0C8Z9pQ8stBHfHZ3npLPF-8-7T8Ul1fvP-7PLwujWJkKyyxI7LiQ0EnOpOEaATqu6o7J0nYHaayspJS2FqrEBjRYYytpmWwqIUCekrONOwX_fcaY2sFFg32_7aPldbZzziv1H1KhdVkzWWfpy7-k134OebRfQKFk1dQ6q_imMnl_MaBtp-AGCEvLWbsGod2C0OYgtGsQ2tXz4o48Hwbs7h2_fz4LxCaI-Wn8iuGP1v-k_gRdBcM9</recordid><startdate>20161101</startdate><enddate>20161101</enddate><creator>Cheng, Xing</creator><creator>Long, Hou-Qing</creator><creator>Xu, Jing-Hui</creator><creator>Huang, Yang-Liang</creator><creator>Li, Fo-Bao</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>20161101</creationdate><title>Comparison of unilateral versus bilateral percutaneous kyphoplasty for the treatment of patients with osteoporosis vertebral compression fracture (OVCF): a systematic review and meta-analysis</title><author>Cheng, Xing ; Long, Hou-Qing ; Xu, Jing-Hui ; Huang, Yang-Liang ; Li, Fo-Bao</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c405t-f0fa3ed123ad3103c16eaad148d035fdb3cf37333f8245e9a6afcf73f039722a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Fractures, Compression - surgery</topic><topic>Humans</topic><topic>Kyphoplasty - adverse effects</topic><topic>Kyphoplasty - methods</topic><topic>Kyphoplasty - statistics & numerical data</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Neurosurgery</topic><topic>Operative Time</topic><topic>Original Article</topic><topic>Osteoporotic Fractures - surgery</topic><topic>Pain, Postoperative</topic><topic>Spinal Fractures - surgery</topic><topic>Surgical Orthopedics</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cheng, Xing</creatorcontrib><creatorcontrib>Long, Hou-Qing</creatorcontrib><creatorcontrib>Xu, Jing-Hui</creatorcontrib><creatorcontrib>Huang, Yang-Liang</creatorcontrib><creatorcontrib>Li, Fo-Bao</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>European spine journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cheng, Xing</au><au>Long, Hou-Qing</au><au>Xu, Jing-Hui</au><au>Huang, Yang-Liang</au><au>Li, Fo-Bao</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparison of unilateral versus bilateral percutaneous kyphoplasty for the treatment of patients with osteoporosis vertebral compression fracture (OVCF): a systematic review and meta-analysis</atitle><jtitle>European spine journal</jtitle><stitle>Eur Spine J</stitle><addtitle>Eur Spine J</addtitle><date>2016-11-01</date><risdate>2016</risdate><volume>25</volume><issue>11</issue><spage>3439</spage><epage>3449</epage><pages>3439-3449</pages><issn>0940-6719</issn><eissn>1432-0932</eissn><abstract>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, weighted mean difference (WMD) −19.74 (−30.56, −8.92)]. There was no significant difference in the short-term postoperative VAS scores [
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, WMD −1.56 (−1.59, −1.16)]. The restoration rate in the bilateral groups was higher than the unilateral groups [
P
< 0.05, WMD −7.82 (−12.23, −3.41)]. There was no significant difference in the risk ratio of cement leakage [
P
> 0.05, RR 0.86 (0.36, 2.06)] and postoperative adjacent-level fractures [
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
< 0.05, WMD −5.69 (−10.67, −0.70)].
Conclusions
A definitive verdict could not be reached regarding which approach is better for the treatment of OVCF. Although unilateral PKP was associated with shorter operative time, less X- ray exposure frequency and dosage of PMMA than bilateral PKP. There was no apparent difference in the short- and long-term clinical outcomes and complications between them. However, bilateral PKP approaches were higher than unilateral PKP in term of the restoration rate. But on account of lack of some high-quality evidence, we hold that amounts of high-quality randomized controlled trials should be required and more complications should be analysed to resolve which surgical approach is better for the treatment of OVCF in the future.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>26814475</pmid><doi>10.1007/s00586-016-4395-6</doi><tpages>11</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0940-6719 |
| ispartof | European spine journal, 2016-11, Vol.25 (11), p.3439-3449 |
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| language | eng |
| recordid | cdi_proquest_miscellaneous_1837311174 |
| source | Springer Nature |
| 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 |
| title | Comparison of unilateral versus bilateral percutaneous kyphoplasty for the treatment of patients with osteoporosis vertebral compression fracture (OVCF): a systematic review and meta-analysis |
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