Comparing complications of vertebroplasty and kyphoplasty for treating osteoporotic vertebral compression fractures: a meta-analysis of the randomized and non-randomized controlled studies.

PURPOSE:

To compare complications of percutaneous vertebroplasty (PVP) and balloon kyphoplasty (BKP) for the treatment of osteoporotic vertebral compression fractures (OVCFs).

BACKGROUND:

PVP and BKP are two minimally invasive procedures for treating OVCFs, while few studies emphases attention to intra- and post-operative complications about the two procedures.

METHODS:

Online databases were searched for studies comparing complications of PVP and BKP for OVCFs, the randomized controlled trials, clinical controlled trials and cohort studies that provided related data were identified. Demographic characteristics and complications related to procedures were extracted and analysed from all of the included studies.

RESULTS:

Nineteen studies encompassing 1,787 patients in total, of whom 887 received PVP and 900 received BKP, met the inclusion criteria. For subsequent fractures, our meta-analysis detected no significant difference between the two procedures, both for adjacent fractures (p = 0.29) and non-adjacent fractures (p = 0.37). For cement extravasations, there was no significant difference between the two interventions if considering disc spaces extravasations only (p = 0.24), while considering total extravasations and paravertebral extravasations, the cement leakage rate in the PVP group was significantly higher than the BKP group (total: p < 0.01; paravertebral: p < 0.01).

CONCLUSIONS:

The two procedures suffer from equal risk of subsequent spinal fractures; PVP has a significant higher cement leakage rate compared to BKP, mainly caused by a higher paravertebral leakage, patients with extremely poor pulmonary function or unstable haemodynamic are better candidates for BKP.