Background: Because of an aging population,osteoporotic vertebral fractures are becoming more
frequent. Conservative therapy was considered the gold standard for treating osteoporotic vertebral
compression fractures (OVCFs) in the past. Percutaneous vertebroplasty (PVP) or balloon kyphoplasty (BKP)
as minimally invasive techniques are new treatments that arewidely used for painful OVCFs. However,
an increase in new vertebral compression fractures at non-treated levels following augmentation is of
concern. There is no convincing evidence that new fractures are inevitable after augmentation compared
to after conservative treatment, and it is still unclear whether further fractures are the consequence of
augmentation ora result of the natural progression of osteoporosis.
Objective: The objective of this study was to evaluate the new-level fracture risk after PVP or BKP
compared with conservative (non-operative) treatment and to determine the dominant risk factor
associated with new OVCFs.
Study Design: A meta-analysis of comparative studies was performed to evaluate the incidence of new
vertebral fractures between vertebral augmentation, such as vertebroplasty and kyphoplasty, and no operation.
Setting: The PubMed,ISI Web of Science, ELSEVIER ScienceDirect, and Cochrane Library databases and
abstracts published in annual proceedings were systematically searched.In addition, we also retrieved data
from references when titles met our inclusion criteria.
Methods: Detailed searches of a number of online databases comparing operative and non-operative
groups were performed. We included randomized controlled trials,clinical controlled trials,and prospective
clinical studies to provide available data. All studies were reviewed by 2 reviewers independently, and all
the references that met our inclusion criteria were searched for additional trials, using the guidelines set
by the QUOROM (Quality of Reporting of Meta-analysis) statement.
Results: We evaluated 12 studies encompassing 1,328 patients in total,including 768 who underwent
operation with polymethylmethacrylateand 560 who received non-operative treatments. For new-level
vertebral fractures, our meta-analysis found no significant difference between the 2 methods, including
total new fractures (P = 0.55) and adjacent fractures (P = 0.5).For pre-existing vertebral fractures, there
was no significant difference between the 2 groups (operative and non-operative groups) (P = 0.24).
Additionally,there was no significant difference in bone mineral density, both in the lumbar (P = 0 .13) and
femoral neck regions (P = 0.37), between the 2 interventions.
Limitation: All studies we screened were published online except for unpublished articles. Moreover,
only a few data sources could be extracted from the published studies. There were only 5 randomized
clinical trials and 7 prospective studies that met our inclusion criteria.
Conclusion: Vertebral augmentation techniques, such as vertebroplasty and kyphoplasty, have been widely
used to treat osteoporotic vertebral fractures in order to alleviate back pain and correct the deformity, and it
has been frequently reported that many new vertebral fractures occurred after this operation. Our analysis
did not reveal evidence of an increased risk of fracture of vertebral bodies, especially those adjacent to the
treated vertebrae, following augmentation with either method compared with conservative treatment.
Key words: Vertebroplasty, kyphoplasty, new osteoporotic compression vertebral fracture, meta-analysis
Comparison of Percutaneous Vertebroplasty and Percutaneous Curved Vertebroplasty for Osteoporotic Vertebral Compression Fractures: Distribution of Bone Cement and Complication
