Predictive risk factors for recollapse of cemented vertebrae after percutaneous vertebroplasty: A meta-analysis

Yi-Hang Ma; Zhi-Sen Tian; Hao-Chuan Liu; Bo-Yin Zhang; Yu-Hang Zhu; Chun-Yang Meng; Xiang-Ji Liu; Qing-San Zhu

doi:10.12998/wjcc.v9.i12.2778

Predictive risk factors for recollapse of cemented vertebrae after percutaneous vertebroplasty: A meta-analysis

World J Clin Cases. 2021 Apr 26;9(12):2778-2790. doi: 10.12998/wjcc.v9.i12.2778.

Authors

Yi-Hang Ma¹, Zhi-Sen Tian¹, Hao-Chuan Liu¹, Bo-Yin Zhang¹, Yu-Hang Zhu¹, Chun-Yang Meng¹, Xiang-Ji Liu¹, Qing-San Zhu²

Affiliations

¹ Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China.
² Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China. zhuqs@jlu.edu.cn.

Abstract

Background: As one of the most common complications of osteoporosis, osteoporotic vertebral compression fracture (OVCF) increases the risk of disability and mortality in elderly patients. Percutaneous vertebroplasty (PVP) is considered to be an effective, safe, and minimally invasive treatment for OVCFs. The recollapse of cemented vertebrae is one of the serious complications of PVP. However, the risk factors associated with recollapse after PVP remain controversial.

Aim: To identify risk factors for the recollapse of cemented vertebrae after PVP in patients with OVCFs.

Methods: A systematic search in EMBASE, MEDLINE, the Cochrane Library, and PubMed was conducted for relevant studies from inception until March 2020. Studies investigating risk factors for the recollapse of cemented vertebrae after PVP without additional trauma were selected for analysis. Odds ratios (ORs) or standardized mean differences with 95% confidence interval (CI) were calculated and heterogeneity was assessed by both the chi-squared test and the I-squared test. The methodological quality of the included studies was assessed according to the Newcastle-Ottawa Scale.

Results: A total of nine case-control studies were included in our meta-analysis comprising 300 cases and 2674 controls. The significant risk factors for the recollapse of cemented vertebrae after PVP in OVCF patients were fractures located at the thoracolumbar junction (OR = 2.09; 95%CI: 1.30 to 3.38; P = 0.002), preoperative intravertebral cleft (OR = 2.97; 95%CI: 1.93 to 4.57; P < 0.00001), and solid lump distribution pattern of the cement (OR = 3.11; 95%CI: 1.91 to 5.07; P < 0.00001). The analysis did not support that age, gender, lumbar bone mineral density, preoperative visual analogue scale score, injected cement volume, intradiscal cement leakage, or vertebral height restoration could increase the risk for cemented vertebra recollapse after PVP in OVCFs.

Conclusion: This meta-analysis suggests that thoracolumbar junction fractures, preoperative intravertebral cleft, and solid lump cement distribution pattern are associated with the recollapse of cemented vertebrae after PVP in OVCF patients.

Keywords: Cemented vertebrae; Meta-analysis; Osteoporotic vertebral compression fracture; Recollapse; Risk factors; Vertebroplasty.