Comparison between vertebroplasty with high or low viscosity cement augmentation or kyphoplasty in cement leakage rate f
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REVIEW ARTICLE
Comparison between vertebroplasty with high or low viscosity cement augmentation or kyphoplasty in cement leakage rate for patients with vertebral compression fracture: a systematic review and network meta‑analysis Wei Cheng Chen1,2 · Sung Huang Laurent Tsai3,4,5 · Anshit Goyal6 · Tsai‑Sheng Fu3,4 · Tung‑Yi Lin3,4 · Mohamad Bydon6 Received: 25 July 2020 / Accepted: 9 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose This study aims to determine whether outcomes following vertebroplasty with high viscosity cement are superior to low viscosity cement and non-inferior to kyphoplasty in the setting of vertebral compression fractures. Methods We searched for randomized controlled trials and cohort studies assessing cement leakage rate in adult patients with VCFs who underwent vertebroplasty with high (HVCV) or low viscosity cement (LVCV) augmentation, or kyphoplasty (KP) in PubMed, Embase, Ovid, The Cochrane Library, and Web of Science from inception up to December 2019. Two authors extracted data and appraised risk of bias. We performed pairwise meta-analyses in R to compare differences between three treatments and network meta-analysis using frequentist random-effects models for indirect comparison. We used P-score to rate the overall certainty of evidence. The primary outcome was cement leakage rate. Results Five RCTs and eight cohort studies with 840 patients and a total of 1280 vertebral bodies were included in the systematic review and network meta-analysis. Compared to LVCV, the relative risk for cement leakage following HVCV and KP was 0.42 (95% CI 0.28–0.61) and 0.83 (95% CI 0.40–1.68), respectively. Our pooled results suggested that HVCV (P-score = 0.99) was better than KP (P-score = 0.36) in cement leakage rate. Conclusions The present network meta-analysis demonstrated that HVCV may be associated with lower risk of cement leakage among patients with VCFs as compared to other augmentation techniques. Future prospective studies will validate the findings of this analysis and further elucidate the risk of symptomatic cement leakage. Keywords Vertebral compression fracture · Vertebroplasty · Kyphoplasty · Cement leakage
Wei Cheng Chen and Sung Huang Laurent Tsai have contributed equally to the manuscript. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00586-020-06636-9) contains supplementary material, which is available to authorized users. * Mohamad Bydon [email protected] 1
National Yang Ming University, Taipei, Taiwan
2
Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan
3
Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, Taiwan
Abbreviations CI Confidence interval HVC High viscosity cement HVCV High viscosity cement vertebroplasty KP Kyphoplasty LVC Low viscosity cement LVCV Low viscosity cement vertebroplasty MCVC Medium viscosity cement vertebroplasty 4
School of Medicine, Chang Gung University, Taoyuan 3
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