Interventions For Osteoporotic Vertebral Compression Fractures:A Network Meta-analysis

?Objective?The purpose of this study is to comprehensively assess the relative efficacy and safety of balloon kyphoplasty(BK),percutaneous vertebroplasty(PVP),and non-surgical treatment(NST)for patients with osteoporotic vertebral compression fractures(OVCFs)using a network meta-analysis.?Methods?We comprehensively searched PubMed,EMBASE and the Cochrane Library.Based on the preplanned eligibility criteria,we screened and included randomized controlled trials comparing percutaneous vertebroplasty(PVP),balloon kyphoplasty(BK),and non-surgical treatment(NST)for patients with osteoporotic vertebral compression fractures(OVCFs).The risk of bias for individual studies were appraised according to the Cochrane Handbook.Network meta-analysis was conducted with a Bayesian framework using R software.?Results?Of the 1057 relevant literatures,15 studies met inclusion criteria with 2092 patients.One trial was graded as low risk of bias,twelve were at high risk of bias,and the rest were classified as unclear risk of bias.14 trials were included in the analysis of pain.Network meta-analyses showed that compared with NST,PVP significantly decreased the pain scores(MD=-0.85,95%CrI=-1.4~-0.28).BK was not significantly different from NST(MD=-0.34,95%CrI=-1.2~0.49)and PVP(MD=0.51,95%CrI=-0.35~1.4).Pairwise meta-analyses indicated that compared with NST,BK significantly decreased the pain scores(MD=-0.83,95%CI=-1.41~-0.25,P=0.005).The other results were consistent with those of network meta-analyses.Six trials were included in the analysis of ODI.Network meta-analyses showed that compared with NST,PVP significantly decreased the ODI scores(MD=-11,95%CrI=-20~-1.4).BK was not significantly different from NST(MD=-10,95%CrI=-26~5.3)and PVP(MD=0.11,95%CrI=-13~13).In pairwise meta-analyses,no comparisons were found between BK and NST.The other results were consistent with those of network meta-analyses.Four studies were included in the analysis of RMDQ.Network meta-analyses showed that compared with NST,PVP significantly decreased the pain scores(MD=-3,95%CrI=-6.6~-0.27).BK was not significantly different from NST(MD=-1.8,95%CrI=-6.0~1.8)and PVP(MD=1.2,95%CrI=-2.7~5.4).Pairwise meta-analyses indicated that compared with NST,BK significantly decreased the pain scores(MD=-1.60,95%CI=-3.08~-0.12,P=0.03).The other results were consistent with those of network meta-analyses.The EQ-5D scores,SF-36 PCS scores,and the risk of subsequent vertebral fractures,adjacent vertebral fractures,and re-fractures at treated level after patients with OVCFs undergoing the three interventions did not differ significantly.The results of pairwise meta-analyses were consistent with those of network meta-analyses.?Conclusions?1.In terms of improving pain,PVP was superior to NST,PVP was not significantly different from BK,and further studies were required to compare BK with NST.2.In terms of improving functional disorder,PVP was superior to NST,there was no significant difference between PVP and BK,and further studies were needed to compare BK with NST.3.In terms of improving quality of life,there was no significant difference between PVP,BK and NST.4.The risk of subsequent vertebral fractures,adjacent vertebral fractures,and re-fractures at treated level after patients with OVCFs undergoing the three interventions did not differ significantly.