Meta analysis of effectiveness of high-viscosity and low-viscosity bone cement vertebroplasty for osteoporotic vertebral compression fractures

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Objective To evaluate the efficacy and safety of high viscosity and low viscosity cement vertebroplasty for osteoporotic vertebral compression fractures (OVCF).Methods The Cochrane Library,Medline,Embase,PubMed,Ovid as well as the Wanfang database and the China Knowledge Network database were searched for all randomized controlled trials (RCTs) of vertebroplasty [percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP)] with high-viscosity bone cement (high-viscosity group) and low-viscosity bone cement (low-viscosity group) in the treatment of OVCF.Methodological quality of the included literature was assessed using the Cochrane Risk Assessment Tool.Stata 12.0 was used for meta analysis to compare the differences of bone cement injection volume,visual analogue score (VAS),Oswestry dysfunction index (ODI),Cobb angle and cement leakage rate between high and low viscosity groups.Subgroup analysis was used to investigate the cement leakage rate in PVP and PKP group.Results A total of nine articles were included,involving 637 patients (with 329 in the low-viscosity group and 308 in the high-viscosity group).Compared with Iow-viscosity group,high-viscosity group was associated with a lower VAS score (WMD =-0.53,95％ CI-0.75--0.30,P ＜0.05),ODI score (WMD =-3.58,95％ CI-5.80--1.36,P ＜ 0.05),Cobb angle (WMD =-2.78,95％CI-4.39--1.18,P ＜ 0.05),and cement leakage rate (RR =0.38,95％ CI 0.29-0.51,P ＜ 0.05).There was no significant difference in the bone cement volume between the two groups (WMD =-0.01,95 ％ CI-0.57-0.54,P ＞ 0.05).Subgroup analysis showed that the cement leakage rate in the high viscosity group was significantly lower than that in the low-viscosity group,regardless of the surgery method (PKP or PVP) (P ＜0.05).In terms of VAS score,ODI score and Cobb angle,the high viscosity group showed better results than the low-viscosity group only in PVP (P ＜ 0.05),not in PKP (P ＞ 0.05).Conclusion Compared with low-viscosity cemented vertebroplasty,high-viscosity cement vertebroplasty has better clinical effect and lower leakage rate in the treatment of 0VCF,which is worthy of further investigation.