Cement Leakage in Vertebral Compression Fractures Between Unilateral and Bilateral Percutaneous Vertebral Augmentation: A Meta-Analysis.

Abstract

Cement leakage remains a significant clinical problem associated with vertebroplasty and kyphoplasty procedures, with uncontrolled cement flow in the posterior direction causing leakage into the vertebral veins or spinal canal that leads to potentially serious clinical complications. This meta-analysis compared the incidences of cement leakage between unilateral and bilateral percutaneous vertebral augmentation (PVA) in the treatment of osteoporosis vertebral compression fractures. Pertinent studies were identified by a search of the PubMed, Embase, and Web of Science databases up to December 2020. The risk ratio (RR) or weighted mean difference (WMD) was applied to combine the results, and a random-effects or a fixed-effects model was used to pool the results depending on the heterogeneity among studies. Publication bias was estimated using Egger's regression asymmetry test. A total of 16 trials (including 9 RCTs and 7 cohort studies) met the inclusion criteria and were included in this meta-analysis. The incidences of cement leakage were similar between the bilateral PVA and unilateral PVA groups (RR = 0.80, 95%CI: 0.57, 1.11; P = 0.182) but unilateral PVA required less cement volume (WMD = -1.34 ml, 95%CI: -1.87, -0.81; P 0.001). Subgroup analysis revealed that the incidence of cement leakage was significantly lower in the unilateral PKP group than in the bilateral PKP group (RR = 0.65, 95%CI: 0.44, 0.97; P = 0.034). The incidences of cement leakage were similar between unilateral and bilateral PVA, but unilateral PVA required less cement. More large-scale studies are needed to verify our findings.