Risk of adjacent level fracture after percutaneous vertebroplasty and kyphoplasty vs natural history for the management of osteoporotic vertebral compression fractures: a network meta-analysis of randomized controlled trials

被引：11

作者：

Essibayi, Muhammed Amir ^{[1
,2
,3
]}

Mortezaei, Ali ^{[3
]}

Azzam, Ahmed Y. ^{[3
]}

Bangash, Ali Haider ^{[3
]}

Eraghi, Mohammad Mirahmadi ^{[3
]}

Fluss, Rose ^{[1
]}

Brook, Allan ^{[4
]}

Altschul, David J. ^{[1
,3
]}

Yassari, Reza ^{[1
,5
]}

Chandra, Ronil V. ^{[6
,7
]}

Cancelliere, Nicole M. ^{[8
,9
]}

Pereira, Vitor Mendes ^{[8
,9
]}

Jennings, Jack W. ^{[10
]}

Gilligan, Christopher J. ^{[11
]}

Bono, Christopher M. ^{[12
,13
]}

Hirsch, Joshua A. ^{[14
,15
]}

Dmytriw, Adam A. ^{[8
,9
,14
]}

机构：

[1] Albert Einstein Coll Med, Montefiore Med Ctr, Dept Neurol Surg, Bronx, NY USA

[2] Mayo Clin, Dept Radiol, Rochester, NY USA

[3] Albert Einstein Coll Med, Montefiore Med Ctr, Montefiore Einstein Cerebrovasc Res Lab, Bronx, NY USA

[4] Albert Einstein Coll Med, Montefiore Med Ctr, Dept Neuroradiol, Bronx, NY USA

[5] Albert Einstein Coll Med, Montefiore Med Ctr, Montefiore Spine Res Grp, Bronx, NY USA

[6] Monash Hlth, Dept Intervent Neuroradiol, Clayton, Vic, Australia

[7] Monash Univ, Dept Image, Fac Med Nursing & Hlth Sci, Clayton, Vic, Australia

[8] Univ Toronto, St Michaels Hosp, Neurovasc Ctr, Div Therapeut Neuroradiol, Toronto, ON, Canada

[9] Univ Toronto, St Michaels Hosp, Neurovasc Ctr, Div Neurosurg, Toronto, ON, Canada

[10] Washington Univ St Louis, Mallinckrodt Inst Radiol, Sch Med, Musculoskeletal Radiol, St Louis, MO USA

[11] Robert Wood Johnson Univ Hosp, New Brunswick, NJ USA

[12] Massachusetts Gen Hosp, Dept Orthoped, Boston, MA USA

[13] Harvard Med Sch, Brigham & Womens Hosp, Boston, MA USA

[14] Harvard Med Sch, Massachusetts Gen Hosp, Neuroendovasc Program, Boston, MA 02115 USA

[15] Harvey L Neiman Hlth Policy Inst, Reston, VA USA

来源：

EUROPEAN RADIOLOGY | 2024年 / 34卷 / 11期

关键词：

Vertebroplasty; Kyphoplasty; Compression fracture; Osteoporotic fracture; QUALITY-OF-LIFE; BALLOON-KYPHOPLASTY; FOLLOW-UP; AUGMENTATION; CEMENT; SAFETY;

D O I：

10.1007/s00330-024-10807-3

中图分类号：

R8 [特种医学]; R445 [影像诊断学];

学科分类号：

1002 ; 100207 ; 1009 ;

摘要：

ObjectivesPercutaneous vertebroplasty and kyphoplasty are common interventions for osteoporotic vertebral compression fractures. However, there is concern about an increased risk of adjacent-level fractures after treatment. This study aimed to compare the risk of adjacent-level fractures after vertebroplasty and kyphoplasty with the natural history after osteoporotic vertebral compression fractures.Materials and methodsA network meta-analysis of randomized controlled trials (RCTs) was conducted to evaluate the risk of adjacent-level fractures after vertebroplasty and kyphoplasty compared to the natural history after osteoporotic vertebral compression fractures. Frequentist network meta-analysis was conducted using the "netmeta" package, and heterogeneity was assessed using Q statistics. The pooled risk ratio (RR) and 95% confidence intervals (CI) were calculated using random effects.ResultsTwenty-three RCTs with a total of 2838 patients were included in the analysis. The network meta-analysis showed comparable risks of adjacent-level fractures between vertebroplasty, kyphoplasty, and natural history after osteoporotic vertebral compression fractures with a mean follow-up of 21.2 (range: 3-49.4 months). The pooled RR for adjacent-level fractures after kyphoplasty compared to natural history was 1.35 (95% CI, 0.78-2.34, p = 0.23) and for vertebroplasty compared to natural history was 1.16 (95% CI, 0.62-2.14) p = 0.51. The risk of bias assessment showed a low to moderate risk of bias among included RCTs.ConclusionThere was no difference in the risk of adjacent-level fractures after vertebroplasty and kyphoplasty compared to natural history after osteoporotic vertebral compression fractures. The inclusion of a large patient number and network meta-analysis of RCTs serve evidence-based clinical practice.Clinical relevance statementThe risk of adjacent-level fracture following percutaneous vertebroplasty or kyphoplasty is similar to that observed in the natural history after osteoporotic vertebral compression fractures.Key Points...

引用

页码：7185 / 7196

页数：12

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