Risk of subsequent adjacent fractures after vertebral augmentation: A systematic review

Background: The incidence of vertebral fractures is high and the new treatment options developed in recent years represent a significant improvement, although they are not without complications. Objectives: The aim of this study was to investigate whether percutaneous vertebral augmentation (PVA) was associated with clinical and radiological subsequent adjacent fractures. Methods: A systematic review and meta-analysis was performed searching on PubMed, EMBASE, Cochrane library, Google Scholar, Web of Science, and ClinicalTrial.gov from the establishment of the database to January 2020. Eligible studies assessing the subsequent adjacent fractures after PVA compared with conservative treatment (CT) were incorporated. The pooled risk ratio (RR) with its 95% confidence intervals (95% CI) was used. Heterogeneity, sensitivity, and publication bias analyses were performed. Results: Twenty-four studies were considered eligible and were included finally. 20/421 patients (4.75%) had clinical subsequent adjacent fractures from the PVA group, and 25/359 patients (6.96%) had from the CT group, and 46/440 patients (10.45%) from the PVA group and 36/444 patients (8.10%) from the CT group had radiological subsequent adjacent fractures. There both had no significant difference between two groups (RR = 0.67, 95%CI: [0.38, 1.19], p = 0.17)/(RR = 1.13, 95% CI: [0.75, 1.70], p = 0.576). However, in fractured vertebrae, number in the PVA group was more than that in the CT group (RR=1.41, 95%CI: [1.03, 1.93], p = 0.03). Conclusion: Collectively, currently available literature provides data showed that PVA did not increase the incidence for subsequent adjacent fractures, no matter it was clinical or radiological fracture. However, PVA may increase the number of fractured vertebrae.