Vertebroplasty with high‐viscosity cement versus conventional kyphoplasty for osteoporotic vertebral compression fractures: a meta‐analysis

Background To evaluate outcomes following percutaneous vertebroplasty with high viscosity cement (PVP‐HVC) and percutaneous kyphoplasty (PKP) with normal‐viscosity cement in patients with osteoporotic vertebral compression fractures (OVCFs). Methods Pertinent studies were retrieved by searching five electronic databases up to July 2021. Additional records were identified via hand‐searching of related references. Risk ratio (RR) and weighted mean difference (WMD), with their 95% confidence intervals (CIs), were calculated. A trial sequential analysis (TSA) was done for cement leakage. Results Twelve studies, embracing 1050 patients with OVCFs, were included. PVP‐HVC was superior to PKP with normal‐viscosity cement regarding risk of cement leakage (RR: 0.67, 95% CI: 0.54–0.83, I2: 45.1%) and operation time (WMD: −11.26, 95% CI: −14.78 to −8.34, I2: 88.8%). However, TSA revealed that a sufficient level of evidence for leakage reduction may have yet to be reached. PKP groups had a significant decrease in Cobb's angles postoperatively (within 1 month, WMD: 2.68, 95% CI: 1.85–3.48, I2: 0%; after 1 year, WMD: 2.68, 95% CI: 1.35–4.01, I2: 0%). There are no significant differences between the two procedures pertaining to injected cement volume, Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and risk of adjacent vertebral fractures. Conclusion PVP‐HVC and PKP with normal‐viscosity cement are safe and effective treatments for the management of OVCF, but the former is superior to the latter in terms of procedure time. The potential of PVP‐HVC in reducing cement leaks remains to be validated by more well‐designed studies. 1. This is the first meta‐analysis to directly compare vertebroplasty with high‐viscosity cement versus kyphoplasty with normal‐viscosity cement for osteoporotic vertebral compression fractures. 2. Overall results indicated a trend that vertebroplasty with high‐viscosity cement may help cement leakage reduction but trial sequential analysis revealed the need of additional studies for confirming this trend.