Is There a Difference in Postoperative Outcomes Between Kyphoplasty and Vertebroplasty in the Management of Vertebral Compression Fractures?: A Meta-Analysis of Randomized Controlled Trials.

The Journal of Bone & Joint Surgery Pub Date : 2025-07-21 DOI:10.2106/jbjs.24.01191

Mohammad Daher,Marven Aoun,Andrew Xu,Alan H Daniels,Amer Sebaaly

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Abstract

BACKGROUND Cement augmentation using vertebroplasty (VP) or kyphoplasty (KP) can be employed to manage vertebral compression fractures (VCFs). Randomized controlled trials (RCTs) have disagreed about the superiority of one technique over the other. Therefore, a meta-analysis of RCTs is warranted. METHODS PubMed, Cochrane, Embase, and Google Scholar were searched for articles from database inception to July 15, 2024. The inclusion criteria consisted of English and non-English-language RCTs comparing KP to VP in the management of VCFs. The studied outcomes were the risks of cement leakage and adjacent vertebral fractures (AVFs), operative time, the postoperative local kyphotic angle, and postoperative back pain. RESULTS A total of 11 RCTs were included, comprising 1,190 patients, of whom 600 (50.4%) underwent KP and 590 (49.6%) underwent VP. We found no difference in the risk of cement leakage (risk ratio [RR], 1.07; 95% confidence interval [CI], 0.68 to 1.69; p = 0.78) or AVFs (RR, 0.60; 95% CI, 0.29 to 1.23; p = 0.16) between the 2 groups. With the inclusion of additional trials, the KP group had a lower risk of AVFs (RR, 0.58; 95% CI, 0.34 to 0.98; p = 0.04). We found no difference in operative time (mean difference, 4.75 minutes; 95% CI, -7.34 to 16.84; p = 0.44) or postoperative pain (mean difference, -0.48; 95% CI, -1.91 to 0.95; p = 0.51) between the 2 groups. A lower postoperative kyphotic angle was observed in the KP group (standardized mean difference, -2.97; 95% CI, -5.62 to -0.32; p = 0.03). CONCLUSIONS This meta-analysis revealed that KP was associated with a better postoperative local kyphotic angle and a lower risk of AVFs, with no difference in postoperative pain or cement leakage, compared with VP. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

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椎体压缩性骨折后凸成形术和椎体成形术的术后疗效有差异吗？随机对照试验的荟萃分析。

背景椎体成形术（VP）或后凸成形术（KP）的水泥增强可用于治疗椎体压缩性骨折（vcf）。随机对照试验（rct）不同意一种技术优于另一种技术。因此，有必要对随机对照试验进行荟萃分析。方法检索spubmed、Cochrane、Embase和谷歌Scholar数据库自建库至2024年7月15日的文章。纳入标准包括英语和非英语rct，比较KP和VP在vcf管理中的作用。研究结果包括骨水泥渗漏和相邻椎体骨折（AVFs）的风险、手术时间、术后局部后凸角度和术后背部疼痛。结果共纳入11项随机对照试验，共1190例患者，其中600例（50.4%）行KP， 590例（49.6%）行VP。我们发现水泥渗漏的风险没有差异(风险比[RR]， 1.07；95%置信区间[CI]， 0.68 ~ 1.69；p = 0.78)或AVFs (RR, 0.60；95% CI, 0.29 ~ 1.23；P = 0.16)。在纳入其他试验后，KP组AVFs的风险较低(RR, 0.58；95% CI, 0.34 ~ 0.98；P = 0.04)。两组手术时间无明显差异(平均差4.75分钟；95% CI, -7.34 ~ 16.84；P = 0.44)或术后疼痛(平均差异-0.48；95% CI, -1.91 ~ 0.95；P = 0.51)。KP组术后后凸角度较低(标准化平均差，-2.97；95% CI, -5.62 ~ -0.32；P = 0.03)。该荟萃分析显示，与VP相比，KP与术后更好的局部后凸角度和更低的avf风险相关，在术后疼痛或骨水泥渗漏方面没有差异。证据级别：治疗性i级。参见《作者说明》获得证据级别的完整描述。

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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The Journal of Bone & Joint Surgery

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