Meta-Analysis
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 26, 2021; 9(12): 2778-2790
Published online Apr 26, 2021. doi: 10.12998/wjcc.v9.i12.2778
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
Yi-Hang Ma, Zhi-Sen Tian, Hao-Chuan Liu, Bo-Yin Zhang, Yu-Hang Zhu, Chun-Yang Meng, Xiang-Ji Liu, Qing-San Zhu, Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, Jilin Province, China
Author contributions: Ma YH, Liu HC, and Zhu QS conceived the study idea; Meng CY, Tian ZS, and Zhang BY designed the study protocol; Ma YH and Zhu YH managed the literature search and data acquisition; Liu XJ and Zhu YH performed data analysis; Ma YH drafted the initial manuscript; Meng CY, Liu HC, Liu XJ, Tian ZS, and Zhang BY critically revised the manuscript for important intellectual content; Zhu QS resolved ambiguities during the study and gave final approval of the manuscript.
Conflict-of-interest statement: The authors deny any conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Qing-San Zhu, MD, PhD, Professor, Surgeon, Department of Spine Surgery, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun 130033, Jilin Province, China. zhuqs@jlu.edu.cn
Received: January 21, 2021
Peer-review started: January 21, 2021
First decision: February 11, 2021
Revised: February 18, 2021
Accepted: March 11, 2021
Article in press: March 11, 2021
Published online: April 26, 2021
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: Vertebroplasty, Osteoporotic vertebral compression fracture, Risk factors, Recollapse, Cemented vertebrae, Meta-analysis

Core Tip: The predictive risk factors associated with recollapse after percutaneous vertebroplasty (PVP) in osteoporotic vertebral compression fractures (OVCFs) remain controversial. To our knowledge, this is the first meta-analysis pooling all relevant published data to identify risk factors that may lead to the recollapse of cemented vertebrae after PVP. Three predictive risk factors, including fractures located at the thoracolumbar junction, preoperative intravertebral cleft, and solid lump cement distribution pattern, were associated with the recollapse of cemented vertebrae after PVP in OVCFs. Patients with these conditions should be treated more cautiously, and close follow-up is necessary for surgeons to detect failed PVP early.