Pedicle Screw Fixation Plus Cement Augmentation or Cement augmentation Only for Osteoporotic Vertebral Compression Fracture: A Systematic Review and Meta-Analysis

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery Pub Date : 2025-04-01 DOI:10.1016/j.wneu.2025.123952

Chao Wang MD , Ya-Wei Chu MD , Cheng-Tang Lv MD

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引用次数: 0

Abstract

Background

Osteoporotic vertebral compression fractures (OVCFs) are common fractures and pedicle screw system gains dissatisfactory results since bone mass loss. Cement augmentation (CA) is the most applied surgery modality for OVCFs but with shortcomings. Pedicle screw fixation plus CA (PSF + CA) has been reported superior to CA. This study aims to investigate the impact of PSF + CA on OVCFs.

Methods

We approached databases of PubMed, Europe PMC, Web of Science, CENTRAL, and Embase for studies published up to November 2023. Clinical outcomes (hospital stay, blood loss, cement volume, cement leakage, secondary fracture), radiological outcomes (local kyphotic angle and anterior vertebral height), and subjective outcomes (visual analog scale and Oswestry Disability Index) were extracted. We tested the sensitivity and publication bias, rated evidence, calculated total effect sizes with prediction intervals, and explained heterogeneity.

Results

Six studies were included with 255/339 patients in the PSF + CA group/CA-only group. The result is as follows: the PSF + CA group showed better in local kyphotic angle; anterior vertebral height claimed insufficient support favoring PSF + CA. The CA-only group showed better clinical outcome of hospital stay, blood loss, and operative time. Cement volume and cement leakage difference were not significant. Secondary fractures occurred more in the CA-only group. Visual analog scale scores favored the PSF + CA group, and Oswestry Disability Index results were too inaccurate to conclude.

Conclusions

PSF + CA and CA-only procedures achieved efficient clinical outcomes in OVCFs. PSF + CA showed better strength in deformity correction and long-term maintenance, less strength in incidence of secondary fracture, and more pain relief at the cost of length of hospital stay, blood loss, and operative time.

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椎弓根螺钉固定加骨水泥增强或仅骨水泥增强治疗骨质疏松性椎体压缩性骨折：一项系统综述和荟萃分析。

背景：骨质疏松性椎体压缩性骨折（OVCFs）是一种常见的骨折，椎弓根螺钉系统因骨量丢失而效果不佳。骨水泥增强术（CA）是OVCFs最常用的手术方式，但存在不足。据报道，椎弓根螺钉固定+水泥增强（PSF+CA）优于CA。本研究旨在探讨PSF+CA对ovcf的影响。方法：我们查阅了PubMed、Europe PMC、Web of Science、CENTRAL和Embase数据库中截至2023年11月发表的研究。提取临床结果（住院时间、出血量、水泥体积、水泥渗漏、继发性骨折）、放射学结果（局部后凸角（LKA）和前椎体高度（AVH））和主观结果（视觉模拟评分（VAS）和Oswestry残疾指数（ODI））。我们检验了敏感性和发表偏倚，评估了证据，计算了预测区间的总效应大小，并解释了异质性。结果：纳入了6项研究，PSF+CA组/ CA组共255/339例患者。结果表明：PSF+CA组在LKA中表现较好；AVH声称支持PSF+CA的支持不足。单纯CA组在住院时间、失血量、手术时间等方面表现出较好的临床效果。水泥体积和水泥渗漏差异不显著。单纯CA组继发性骨折发生率更高。VAS评分倾向于PSF+CA组，ODI结果太不准确，无法得出结论。结论：PSF+CA和仅CA治疗OVCFs获得了有效的临床效果。PSF+CA在畸形矫正和长期维持方面表现出更好的力量，在继发性骨折发生率方面表现出更小的力量，在以住院时间、出血量和手术时间为代价的情况下，更能缓解疼痛。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

World neurosurgery CLINICAL NEUROLOGY-SURGERY

CiteScore

3.90

自引率

15.00%

发文量

1765

审稿时长

47 days

期刊介绍： World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The journal''s mission is to: -To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care. -To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide. -To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients. Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS