Unilateral Extrapedicle Versus Bilateral Pedicle Of Percutaneous Verteproplasty For Osteoporotic Vertebral Compression Fractures:a Meta-analysis

Objective:To evaluate the efficacy and safety of percutaneous vertebroplasty through the unilateral extrapedicle approach and the bilateral pedicle approach for the treatment of osteoporotic vertebral compression fracture.Methods:A systematic computer search(from Jan 2002 to Nov 2022)in Pub Med,Cochrane Library,Embase,CNKI,VIP and Wanfang Medical Network database.Formulate the inclusion and exclusion criteria for literature,screen literature according to the criteria and extract the literature data.Review Manager 5.4 and Stata 12.0 was adopted to conduct statistical analysis of data.Results:A total of 9 articles were included,with a total of 611 patients and 618 vertebral bodies.The number of affected vertebrae treated by the bilateral pedicle approach was313.The number of affected vertebrae treated by the unilateral extrapedicle approach was 305.The Visual analog scale(VAS)score,Oswestry disability index,operating time,the number of exposure in X ray,the amount of bone cement injected,the leakage rate of bone cement and the Cobb angle after operation were performed statistical analysis.The VAS score within 1 week after surgery was as follows: Z=0.53,P=0.60(> 0.05),indicating that there was no statistical difference in VAS score between the unilateral extrapedicle group and the bilateral pedicle group in the short term.The VAS score after6 months after surgery was as follows: Z=2.48,P=0.01(< 0.05),indicating that the VAS score of the bilateral pedicle group was better than that of the unilateral extrapedicle group in the medium-term postoperative time(6 months to 1 year).There was no significant difference in postoperative Oswestry disability Index scores between the two groups in the short and medium term(ODI score within 1 week after surgery: Z=0.32,P=0.75;ODI score after 6 months after surgery: Z=0.23,P=0.82).The operating time and the number of exposure in X ray of the unilateral extrapedicle group were significantly better than those of the bilateral pedicle group(P < 0.00001),but there were no significant statistical differences in the amount of bone cement injected(P=0.14),the leakage rate of bone cement(P=0.15),and the Cobb angle after operation(P=0.08)between the two groups.Conclusion:The group of unilateral extrapedicle could effectively shorten the operating time and reduce the times of exposure in X ray.Both of the unilateral extrapedicle approach and the bilateral pedicle approach could relieve pain and improve the quality of life immediately after surgery,both of who can obtain satisfactory results.But with longer follow-up,the bilateral pedicle group was more advantageous in terms of pain VAS score in the medium term(6 months to 1 year),while there was no significant difference in ODI score between the two groups.Therefore,more high-quality,large sample,and long-term follow-up randomized double-blind controlled trials are needed for further study.