Comprehensive systematic-review and meta-analysis: Treatment outcomes of unipedicular vs bipedicular approaches in vertebroplasty and kyphoplasty for osteoporotic vertebral compression fractures

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma Pub Date : 2025-04-16 DOI:10.1016/j.jcot.2025.103010

Tharun Teja Aduri , Mehar Dhillon , Parth Bansal , Arvind Vatkar , Sarvdeep Singh Dhatt , Vishal Kumar

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引用次数: 0

Abstract

Background

Vertebroplasty or kyphoplasty is a safe and effective procedure to treat persistent pain and correct deformity for early mobilisation in an osteoporotic vertebral compression fracture. However, there is conflicting evidence supporting the unipedicular or bipedicular approach in terms of the outcomes and complications with a recent increase in literature and no meta-analysis in this decade. This review is aimed at providing insight into the comparison between unipedicular and bipedicular approaches for making clinical decisions.

Methods

Multiple databases were screened using the keywords: “kyphoplasty”, “vertebroplasty”, “unipedicular”, “bipedicular”, “osteoporotic fracture”, and “compression fracture”, and all the results were reviewed for inclusion of 20 articles and data analysis done to look for significant differences between the two approaches. The quality of the studies included is evaluated using MINORS criteria. This review is registered in the International Prospective Register of Systematic Reviews (PROSPERO) with ID: CRD4202511004028.

Results

We found no significant difference between the two groups in terms of patient-related outcomes (Visual Analogue scale and Oswestry Disability Index), radiological outcomes (kyphotic angle correction or vertebral height restoration), complications (cement leakage or adjacent vertebral fractures), fluoroscopy frequency with significantly less operative time in the unipedicular group.

Conclusion

Vertebroplasty and kyphoplasty, irrespective of unipedicular or bipedicular approach, are effective procedures providing pain relief and adequate functional outcomes with comparable complications, with the unilateral approach taking less operative time. However, in a clinical setting, the approach of kyphoplasty or vertebroplasty should depend on a patient's condition, fracture type and symmetry, along with the levels affected.

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综合系统评价和荟萃分析：单椎弓根入路与双椎弓根入路在骨质疏松性椎体压缩性骨折椎体成形术和后凸成形术中的治疗效果

背景：椎体成形术或后凸成形术是一种安全有效的方法，用于治疗骨质疏松性椎体压缩性骨折的持续疼痛和纠正早期活动的畸形。然而，在结果和并发症方面，支持单椎弓根或双椎弓根入路的证据相互矛盾，最近文献的增加和近十年来的荟萃分析。这篇综述的目的是为临床决策提供单椎弓根和双椎弓根入路的比较。方法以“后凸成形术”、“椎体成形术”、“单椎弓根成形术”、“双椎弓根成形术”、“骨质疏松性骨折”、“压缩性骨折”为关键词，筛选多个数据库，纳入20篇文献并进行数据分析，寻找两种入路的显著差异。纳入研究的质量采用未成年人标准进行评估。该综述已在国际前瞻性系统综述注册（PROSPERO）中注册，ID: CRD4202511004028。结果我们发现两组在患者相关结果（视觉模拟评分和Oswestry残疾指数）、影像学结果（后凸角度矫正或椎体高度恢复）、并发症（水泥渗漏或邻近椎体骨折）、透视次数方面无显著差异，单椎弓根组手术时间明显少于单椎弓根组。结论椎体成形术和后凸成形术，无论是单椎弓根入路还是双椎弓根入路，都是一种有效的手术方法，可以缓解疼痛，获得良好的功能结果，并发症较少，单侧入路手术时间更短。然而，在临床环境中，椎体成形术或后凸成形术的方法应取决于患者的病情，骨折类型和对称性，以及受影响的水平。

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

Journal of Clinical Orthopaedics and Trauma Medicine-Orthopedics and Sports Medicine

CiteScore

4.30

自引率

0.00%

发文量

181

审稿时长

92 days

期刊介绍： Journal of Clinical Orthopaedics and Trauma (JCOT) aims to provide its readers with the latest clinical and basic research, and informed opinions that shape today''s orthopedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. JCOT publishes content of value to both general orthopedic practitioners and specialists on all aspects of musculoskeletal research, diagnoses, and treatment. We accept following types of articles: • Original articles focusing on current clinical issues. • Review articles with learning value for professionals as well as students. • Research articles providing the latest in basic biological or engineering research on musculoskeletal diseases. • Regular columns by experts discussing issues affecting the field of orthopedics. • "Symposia" devoted to a single topic offering the general reader an overview of a field, but providing the specialist current in-depth information. • Video of any orthopedic surgery which is innovative and adds to present concepts. • Articles emphasizing or demonstrating a new clinical sign in the art of patient examination is also considered for publication. Contributions from anywhere in the world are welcome and considered on their merits.