Re-evaluating vertebral height restoration assessment in osteoporotic compression fractures: a systematic review and meta-analysis.

Abstract

Purpose: Vertebral compression fractures (VCFs) are common among the elderly, causing significant morbidity, pain, and disability. This study quantitatively analyzes the vertebral height restoration via Kyphoplasty (KP) and Vertebroplasty (VP), along with the cement volume used and leakage percentage. Our meta-analysis of 14 randomized controlled trials (RCTs) compares these objective outcomes, considering cement volume and leakage in both procedures.

Methods: Databases searched included Medline, PubMed, and Web of Science using MeSH keywords: 'Kyphoplasty,' 'Vertebroplasty,' 'Vertebral height restoration,' 'Bone cement volume,' and 'Vertebral compression fractures.' Fourteen RCTs were selected, focusing on outcomes such as anterior and central vertebral body height, kyphotic angle, cement volume, and leakage. Data analysis included mean values, standard deviations, ranges, Cohen's d-effect sizes, and standard errors, summarized in a forest plotQuery.

Results: The review included 1456 patients (mean age 71.11 years). Follow-up ranged from 1 to 48 months (mean 15 months). KP showed a greater effect size in restoring anterior and central vertebral body height and kyphotic angle. Combined data from KP and VP showed increases of 3.48 mm (19.14%) in anterior vertebral heights, 4.38 mm in central vertebral heights, and a 2.85-degree correction in kyphotic angle.

Conclusions: Both KP and VP effectively restore vertebral height in VCF patients. KP is superior in restoring anterior and central vertebral body height and correcting kyphotic angle. VP, particularly unilateral, shows higher central vertebral height restoration but higher cement leakage. Standardized reporting and patient-specific volumetric assessments are crucial for optimizing vertebral augmentation procedures.