A Systematic Review On Unilateral Versus Bilateral Kyphoplasty For Osteoporotic Vertebral Compression Fractures

OBJECTIVE:To comprehensively evaluate and compare the unilateral and bilateral percutaneous kyphoplasty, and provide evidence for the selection of surgical approach. METHODS:A computer-based online search was done in the English and Chinese databases such as Cochrane Library, PubMed, OVID, Embase, China Biology Medicine disc, Wanfang, and VIP. Nine relevant Chinese orthopedic journals were manually searched from the initial issue to the issue published in March 2014. Randomized controlled trials comparing unilateral and bilateral kyphoplasty for osteoporotic vertebral compression fractures were collected. According to the inclusion and exclusion criteria, two evaluators performed the selection of test, data extraction and quality assessment. RevMan 5.2 software was used for meta-analysis. RESULTS AND CONCLUSION:Eight randomized controlled trials involving 507 patients and 656 vertebral bodies were involved in the result analysis. The results showed that, there was no bone cement leakage between the two groups; preoperative VAS score (WMD=-0.05, P=0.58) at short-term follow-up (≤3 months)(WMD=-0.02, P=0.25) and long-term follow-up (≥12 months) (WMD=0.08, P=0.64) also showed no significant differences between the two groups. Oswestry disability index at short-term follow-up (WMD=0.13, P= 0.73) and long-term follow-up (WMD=0.05, P= 0.98) in the two groups had no statistical significance. This meta-analysis showed significant difference in the bone cement volume and operating time, and the unilateral approach was better than bilateral approach. Radiographic findings showed that, preoperative and postoperative kyphosis angle, as well as restoration rate were not statistically different between the two groups. This meta-analysis comparing unilateral and bilateral percutaneous kyphoplasty for the treatment of osteoporotic vertebral compression fractures demonstrates no significant differences regarding VAS, radiographic outcomes and complications. Considering the operation time and radiation exposure, we recommend unilateral percutaneous kyphoplasty.