SYSTEMATIC REVIEW article
Front. Surg.
Sec. Orthopedic Surgery
Volume 12 - 2025 | doi: 10.3389/fsurg.2025.1591686
In-Depth Meta-Analysis: Unilateral PKP Demonstrates Significant Advantages in Treating Osteoporotic Vertebral Compression Fractures-An Expanded RCT Study with GRADE Scoring
Provisionally accepted
- 1Sixth People's Hospital of Chengdu, Chengdu, Sichuan Province, China
- 2South China University of Technology, Guangzhou, Guangdong Province, China
- 3No.1 Orthopedics Hospital of Chengdu, Chengdu, China
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Background: Percutaneous 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.We conducted a comprehensive systematic review of randomized controlled trials (RCTs) through July 2024, searching major English databases (Cochrane Library, Embase, PubMed, Scopus, Web of Science) and Chinese databases (CNKI, VIP, Wanfang).Results: 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 (VAS) scores (P=0.62), Oswestry Disability Index (ODI) 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.Unilateral PKP offers advantages over bilateral PKP, including shorter operation time, lower PMMA injection dose, reduced radiation exposure, lower bone cement leakage, and fewer complications. Therefore, unilateral PKP may be a preferable option for OVCF patients, providing similar clinical outcomes with reduced procedural risks and resource requirements.
Keywords: Meta-analysis, Osteoporotic vertebral compression fractures, RCTs, Percutaneous kyphoplasty, Unilateral and bilateral
Received: 11 Mar 2025; Accepted: 17 Apr 2025.
Copyright: © 2025 Xiao, Li, Yan, Luo and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Ting Li, No.1 Orthopedics Hospital of Chengdu, Chengdu, China
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