Modified versus conventional percutaneous kyphoplasty for osteoporotic vertebral compression fracture treatment: a systematic review and pilot meta-analysis

Purpose

This study compares the safety and clinical effectiveness of modified percutaneous kyphoplasty (PKP) approaches (transverse process-pedicle or extrapedicular) with the conventional transpedicular approach for treating osteoporotic vertebral compression fractures.

Methods

We searched various databases, including PubMed, Cochrane Library, Web of Science, Embase, and Scopus. Safety outcomes included operative time, radiation dose, injected cement volume, and cement leakage rate, while efficacy outcomes were the Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), Cobb’s angle, and vertebral body height. The quality of cohort studies was assessed using the Newcastle–Ottawa Score, and a meta-analysis was conducted using Review Manager 5.4.

Results

Nine high-quality cohort studies involving 1,187 patients were included. Compared to conventional PKP, the modified approach resulted in significantly shorter operative time (mean differences [MD]: − 11.72, 95% confidence interval [CI]: − 16.56 to − 6.88, p < 0.00001), lower radiation dose (standardized mean differences: − 2.21, 95% CI: − 2.96 to − 1.45, p < 0.00001), reduced injected cement volume (MD: − 0.89, 95% CI: − 1.58 to − 0.21, p = 0.01), and a lower cement leakage rate (MD: 0.58, 95% CI: 0.41–0.80, p = 0.001). However, both groups had no significant differences in VAS score, ODI score, Cobb’s angle, or vertebral body height.

Conclusion

No significant difference in pain relief or functional improvement was observed between modified and conventional PKP. However, modified PKP has a shorter operative time, a lower radiation dose, a lower injected cement volume, and a lower cement leakage rate than conventional PKP. These findings suggest that modified PKP is safer, with similar therapeutic outcomes to conventional PKP.