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
Processing time: 83 Days and 18.7 Hours
ARTICLE HIGHLIGHTS
Research background

Osteoporotic vertebral compression fracture (OVCF) is one of the most common complications of osteoporosis. As a minimally invasive technique for treating OVCFs, percutaneous vertebroplasty (PVP) has been widely used due to its good therapeutic efficacy and safety. However, there have been reports of the cemented vertebra recollapse after PVP, which deserves our attention.

Research motivation

To the best of our knowledge, studies with high-quality and large-scale exploring these risk factors are scarce. The predictive risk factors associated with the recollapse of cemented vertebrae after PVP in OVCFs remain controversial.

Research objectives

We performed this meta-analysis pooling all relevant published data to identify risk factors that might lead to the cemented vertebra recollapse after PVP in OVCFs.

Research methods

A systematic search in EMBASE, MEDLINE, the Cochrane Library, and PubMed was conducted for original articles published up to March 2020. Ten independent variables (age, gender, lumbar bone mineral density, location of the fractured vertebra, preoperative intravertebral cleft, preoperative visual analogue scale score, injected cement volume, intradiscal cement leakage, cement distribution pattern, and vertebral height restoration) were extracted for assessment from the included studies. Review Manager 5.3 was applied for calculating odds ratios (ORs) or standardized mean differences with 95% confidence interval (CI), as well as assessing the heterogeneity by both the chi-squared test and the I-squared test.

Research results

A total of nine case-control studies published between 2008 and 2018 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 OVCFs 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). Furthermore, there was no significant correlation between age, gender, lumbar bone mineral density, preoperative visual analogue scale score, injected cement volume, intradiscal cement leakage, or vertebral height restoration and the cemented vertebra recollapse.

Research conclusions

This meta-analysis supports that three risk factors, including fractures located at the thoracolumbar junction (T10-L2), preoperative IVC, and solid lump distribution pattern of the cement, are associated with the recollapse of cemented vertebrae after PVP in OVCFs.

Research perspectives

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 in OVCFs. These findings through analysis can provide valuable information for current clinical work. Also, some other potential risk factors, such as body mass index, steroid usage, vertebral compression rate, and pedicle approach (unilateral or bilateral), need to be evaluated in the future.