In-depth meta-analysis: unilateral PKP demonstrates significant advantages in treating osteoporotic vertebral compression fractures—an expanded RCT study with GRADE scoring
BackgroundPercutaneous kyphoplasty (PKP) has become a mainstream intervention for osteoporotic vertebral compression fractures (OVCFs). While existing systematic reviews comparing unilateral and bilateral PKP approaches provide preliminary insights, they are limited by methodological inconsistencies...
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Frontiers Media S.A.
2025-05-01
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| Series: | Frontiers in Surgery |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fsurg.2025.1591686/full |
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| author | Lin Xiao Wei Li Jingxin Yan Lei Luo Ting Li |
| author_facet | Lin Xiao Wei Li Jingxin Yan Lei Luo Ting Li |
| author_sort | Lin Xiao |
| collection | DOAJ |
| description | BackgroundPercutaneous kyphoplasty (PKP) has become a mainstream intervention for osteoporotic vertebral compression fractures (OVCFs). While existing systematic reviews comparing unilateral and bilateral PKP approaches provide preliminary insights, they are limited by methodological inconsistencies and inconclusive evidence regarding comparative efficacy.MethodsWe conducted a comprehensive systematic review of randomized controlled trials (RCTs) up to July 2024, searching major English databases (Cochrane Library, Embase, PubMed, Scopus, Web of Science) and Chinese databases (CNKI, VIP, and Wanfang).ResultsThe pooled analysis of 35 RCTs (N = 3,362) revealed no statistically significant differences between unilateral and bilateral PKP in long-term outcomes, including visual analog scale scores (P = 0.62), Oswestry Disability Index scores (P = 0.77), and Cobb angle correction (P = 0.64). However, unilateral PKP demonstrated significant perioperative advantages: shorter operative time (P < 0.00001), a lower dose of bone cement injection (P < 0.00001), and a reduced radiation dose (P < 0.00001). Furthermore, the study also found that unilateral PKP had a lower rate of bone cement leakage (P < 0.0001) and a reduced overall complication rate (P < 0.0001) compared to bilateral PKP.ConclusionUnilateral PKP offers advantages over bilateral PKP, including shorter operation time, lower polymethylmethacrylate injection dose, reduced radiation exposure, lower bone cement leakage, and fewer complications. Therefore, unilateral PKP may be a preferable option for patients with OVCF, providing similar clinical outcomes with reduced procedural risks and resource requirements. |
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| institution | Kabale University |
| issn | 2296-875X |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Surgery |
| spelling | doaj-art-1641dc52531c4cb989f79c0d8aa22e8b2025-08-20T03:49:40ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2025-05-011210.3389/fsurg.2025.15916861591686In-depth meta-analysis: unilateral PKP demonstrates significant advantages in treating osteoporotic vertebral compression fractures—an expanded RCT study with GRADE scoringLin Xiao0Wei Li1Jingxin Yan2Lei Luo3Ting Li4Department of Orthopedics, The Sixth People’s Hospital of Chengdu, Chengdu, ChinaDepartment of Orthopedics, The Sixth People’s Hospital of Chengdu, Chengdu, ChinaSchool of Medicine, South China University of Technology, Guangzhou, ChinaDepartment of Orthopedics, The Sixth People’s Hospital of Chengdu, Chengdu, ChinaDepartment of Orthopedics, No. 1 Orthopedics Hospital of Chengdu, Chengdu, ChinaBackgroundPercutaneous kyphoplasty (PKP) has become a mainstream intervention for osteoporotic vertebral compression fractures (OVCFs). While existing systematic reviews comparing unilateral and bilateral PKP approaches provide preliminary insights, they are limited by methodological inconsistencies and inconclusive evidence regarding comparative efficacy.MethodsWe conducted a comprehensive systematic review of randomized controlled trials (RCTs) up to July 2024, searching major English databases (Cochrane Library, Embase, PubMed, Scopus, Web of Science) and Chinese databases (CNKI, VIP, and Wanfang).ResultsThe pooled analysis of 35 RCTs (N = 3,362) revealed no statistically significant differences between unilateral and bilateral PKP in long-term outcomes, including visual analog scale scores (P = 0.62), Oswestry Disability Index scores (P = 0.77), and Cobb angle correction (P = 0.64). However, unilateral PKP demonstrated significant perioperative advantages: shorter operative time (P < 0.00001), a lower dose of bone cement injection (P < 0.00001), and a reduced radiation dose (P < 0.00001). Furthermore, the study also found that unilateral PKP had a lower rate of bone cement leakage (P < 0.0001) and a reduced overall complication rate (P < 0.0001) compared to bilateral PKP.ConclusionUnilateral PKP offers advantages over bilateral PKP, including shorter operation time, lower polymethylmethacrylate injection dose, reduced radiation exposure, lower bone cement leakage, and fewer complications. Therefore, unilateral PKP may be a preferable option for patients with OVCF, providing similar clinical outcomes with reduced procedural risks and resource requirements.https://www.frontiersin.org/articles/10.3389/fsurg.2025.1591686/fullmeta-analysisosteoporotic vertebral compression fracturesRCTspercutaneous kyphoplastyunilateral and bilateral |
| spellingShingle | Lin Xiao Wei Li Jingxin Yan Lei Luo Ting Li In-depth meta-analysis: unilateral PKP demonstrates significant advantages in treating osteoporotic vertebral compression fractures—an expanded RCT study with GRADE scoring Frontiers in Surgery meta-analysis osteoporotic vertebral compression fractures RCTs percutaneous kyphoplasty unilateral and bilateral |
| title | In-depth meta-analysis: unilateral PKP demonstrates significant advantages in treating osteoporotic vertebral compression fractures—an expanded RCT study with GRADE scoring |
| title_full | In-depth meta-analysis: unilateral PKP demonstrates significant advantages in treating osteoporotic vertebral compression fractures—an expanded RCT study with GRADE scoring |
| title_fullStr | In-depth meta-analysis: unilateral PKP demonstrates significant advantages in treating osteoporotic vertebral compression fractures—an expanded RCT study with GRADE scoring |
| title_full_unstemmed | In-depth meta-analysis: unilateral PKP demonstrates significant advantages in treating osteoporotic vertebral compression fractures—an expanded RCT study with GRADE scoring |
| title_short | In-depth meta-analysis: unilateral PKP demonstrates significant advantages in treating osteoporotic vertebral compression fractures—an expanded RCT study with GRADE scoring |
| title_sort | in depth meta analysis unilateral pkp demonstrates significant advantages in treating osteoporotic vertebral compression fractures an expanded rct study with grade scoring |
| topic | meta-analysis osteoporotic vertebral compression fractures RCTs percutaneous kyphoplasty unilateral and bilateral |
| url | https://www.frontiersin.org/articles/10.3389/fsurg.2025.1591686/full |
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