Is Unilateral Percutaneous Kyphoplasty Superior to Bilateral Percutaneous Kyphoplasty for Osteoporotic Vertebral Compression Fractures? Evidence from a Systematic Review of Discordant Meta-Analyses

摘要

Background: Several meta-analyses have been performed to compare unilateral percutaneouskyphoplasty (PKP) and bilateral PKP in the treatment of osteoporotic vertebral compressionfractures (OVCFs), but inconsistencies in the results have led to questions as to which techniqueis preferable.Objective: This study was designed to clarify the benefits and disadvantages of unilateral PKPversus bilateral PKP as found in numerous discordant meta-analyses and thereby present surgicaltreatment recommendations for OVCFs considering the current best evidence.Study Design: Systematic review/Meta-analysis.Methods: Meta-analyses on unilateral and bilateral PKP for OVCFs were included by searchingPubmed, Embase, and Cochrane library. Meta-analysis quality was assessed using Oxford Levels ofEvidence and Assessment of Multiple Systematic Reviews (AMSTAR). The Jadad decision algorithmwas used to identify the best evidence.Results: Eight eligible meta-analyses were included, 7 of which were Level-II evidence and one wasLevel-III evidence. The AMSTAR scores varied from 7 to 8. The Jadad decision algorithm suggestedthat the best meta-analysis should be selected depending upon publication characteristics andmethodology of primary studies, language restrictions, and whether data analysis was performedon individual patients. The best available evidence indicated that both unilateral and bilateral PKPcould receive similar good clinical and radiological outcomes. However, without increasing the riskof complications, unilateral PKP required shorter surgical time and less cement volume, offeringbetter pain relief and quality of life at post-operative short term follow-ups.