The Incidence of New Vertebral Fractures Following Vertebral Augmentation: A Meta-Analysis of Randomized Controlled Trials.

Abstract

A meta-analysis of randomized controlled trials was performed that compares the relationship between percutaneous vertebral augmentation (PVA) and conservative treatments with the incidence of new vertebral fractures.Using meta-analytic techniques, this study compares PVA and conservative treatment for incidence of new vertebral fractures, particularly incidence of adjacent fractures that occur following treatment.A focus of clinicians has been on whether PVA increases the risk of new vertebral fractures.Pubmed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched to retrieve literature published from the establishment of the databases until April 28, 2015. Literature of related areas was searched manually. The main outcome indicator was the incidence of new vertebral fractures at final follow-up appointment. In addition, we evaluated the incidence of new vertebral fractures in different follow-up periods and the incidence of adjacent fractures. The RevMan 5.3 software program of the Cochrane Collaboration was used to analyze the data. For dichotomous variables, the risk ratio (RR) and a confidence interval (CI) of 95% were used to express the heterogeneity of the effect size.Seven randomized controlled trial studies were selected from the literature. The studies include 871 patients, 436 of whom received PVA treatment and the rest received conservative treatment. Combined analysis of the 7 studies showed that the numbers of new vertebral fractures in the 2 groups are not significantly different. Six studies reported the numbers of new adjacent fractures. Considering the heterogeneity among the studies, 2 subgroups were formed. The 5 studies in the European group showed that the incidence of new adjacent fractures in the PVA-treated group is higher than that in the conservatively treated group, and the difference is statistically significant. The one study in the Asian group showed no significant difference between the incidences of adjacent fractures in the 2 groups.PVA treatment does not increase the incidence of new vertebral fractures. Most studies reported that PVA increases the incidence of adjacent fractures, yet it is rarely stated that both PVA and conservative treatment lead to the same incidence of adjacent fractures.