Extrapedicular vs transpedicular percutaneous kyphoplasty for osteoporotic vertebral compression fractures: A systematic review and meta-analysis

Abstract

Abstract Background: Osteoporotic Vertebral Compression Fractures(OVCFs) is one of the most common health problems in the elderly population. Percutaneous kyphoplasty is a minimally invasive technique that has gained widespread recognition. Transpedicular and extrapedicular are two approaches for kyphoplasty. But over the last decade, the safety and effect of two approaches remain unclear, and there is still a lack if evaluation of their therapeutic effects. Objectives: To assess the efficacy and safety of the two approaches as a treatment for patients with OVCF. Search strategy: We searched CENTRAL; MEDLINE; EMBASE; Chinese Biological Medicine Database; VIP Journals Database; Wan-fang database; CNKI and Chinese Evidence-Based Medicine Database from the their inception to December 2020 in both English and Chinese.We hand searched Chinese language journals and conference proceedings. Selection criteria: Randomised-controlled trials that compared any form of the transpedicular approachto any form of the extrapedicular approach control intervention in the treatment of osteoporotic vertebral compression fracture patients were included. Data collection and analysis: Two review authors(Wu F,Huang ZH)independently determined the studies to be included in the review based on inclusion and exclusion criteria and the exracted data were analysed by RevMan 5.3, and the level of evidence was assessed by the GRADE system. Results: Six randomised controlled trials with a total sample size of 395 patients were included, all of them were from Asian countries. Meta-analysis showed that the extrapedicular approach kyphoplasty is superior to the transpedicular approach kyphoplasty for the less radiology exposure time, less cement volume and a lower leakage rate. But there is no difference between the extrapedicular approach kyphoplasty and the transpedicular approach kyphoplasty with postoperative VAS scores and ODI scores. Limitations: Only 6 randomized controlled trials were selected for analysis, all of studies all published in Chinese, so there may be difficult for English readers to assess. Heterogeneity was detected among the studies when we pooled the outcomes. Conclusion: Based on the evidence of 6 RCTs, the effectiveness of extrapedicular kyphoplasty for the treatment of osteoporotic vertebral compression fracture patients is suggestive. Extrapedicular kyphoplasty have less radiology exposure time, cement volume and a lower leakage rate than transpedicular kyphoplasty, and there is no significant different in VAS and ODI after surgery. With the methodological quality and the small number of the included studies taken into consideration, further more high quality and large scale randomized controlled trials are needed.