The aim of this study was to investigate whether percutaneous vertebral augmentation (PVA) was associated with clinical and radiological subsequent adjacent fractures.
A systematic review and meta-analysis was performed searching on PubMed, EMBASE, Cochrane library, Google Scholar, web of science and ClinicalTrial.gov from the establishment of the database to January 2020. Eligible studies assessing the subsequent adjacent fractures after PVA compared with conservative treatment (CT) were incorporated. The pooled risk ratio (RR) with its 95% confidence intervals (95% CI) was used. Heterogeneity, sensitivity and publication bias analyses were performed.
A total of 24 studies were considered eligible and were included finally. 20/421 patients (4.75%) had clinical subsequent adjacent fractures from PVA group, and 25/359 patients (6.96%) had from CT group, and 46/440 patients (10.45%) from PVA group and 36/444 patients (8.10%) from CT group had radiological subsequent adjacent fractures. There both had no significant difference between two groups (RR=0.67, 95%CI: [0.38, 1.19], P = 0.17)/ (RR=1.13, 95%CI: [0.75, 1.70], P = 0.576). However, in fractured vertebrae, number in PVA group was more than that in CT group (RR=1.41, 95%CI: [1.03, 1.93], P = 0.03).
Collectively, currently available literature provides data showed PVA did not increase the incidence for subsequent adjacent fractures, no matter it was clinical or radiological fracture. But PVA may increase the number of fractured vertebrae.
Table of Contents
ABSTRACT
INTRODUCTION
PATIENTS AND METHODS
RESULTS
DISCUSSIONS
CONCLUSION
REFERENCES
Research Objectives and Key Topics
The primary objective of this study is to investigate whether percutaneous vertebral augmentation (PVA) is associated with an increased incidence of clinical and radiological subsequent adjacent fractures in patients with osteoporotic vertebral compression fractures (OVCFs) compared to conservative treatment.
- Systematic review and meta-analysis of clinical outcomes
- Distinction between clinical and radiological subsequent fractures
- Analysis of the number of fractured patients versus fractured vertebrae
- Comparative effectiveness of PVA versus conservative treatment
- Risk evaluation of subsequent adjacent vertebral fractures
Excerpt from the Book
1 INTRODUCTION:
As one of the most common complications of osteoporosis, osteoporotic vertebral compression fractures (OVCFs) often results in back pain, spinal deformity, functional disability, and even death. So it has become one of the serious diseases threatening the health of elderly patients and increased the economic burden of society [1,2,5,7].
As a minimally invasive therapy for OVCFs, percutaneous vertebral augmentation (PVA) has shown promising and encouraging outcomes compared with conservative treatment (CT) [2, 3,4,6].
Moreover, according to different feature of fracture, PVA can choose percutaneous vertebroplasty (PVP), percutaneous kyphoplasty (PKP) or other operation methods. However, PVA can also lead to serious complications, the most serious of which is subsequent fracture, so the efficacy and safety of PVA are still in dispute [5,8,9,10]. The subsequent fractures can occur at adjacent, non-adjacent or even previously treated vertebral levels.
However, there were few meta-analyses [1,12,13,14,15,36] only to probe subsequent adjacent fractures, and RCTs as much as possible were not included in those reviews.
Furthermore, none of these studies distinguished clinical and radiological fracture, as well as the number of fractured patients and fractured vertebrae for analysis (16,17,18,19). The purpose of this study is to explore the characteristics of subsequent adjacent fracture after PVA, so as to provide evidence for the treatment strategy of OVCF (20,21, 28, 35).
Summary of Chapters
ABSTRACT: Summarizes the study’s objective to compare PVA and conservative treatment regarding subsequent fractures, concluding that while PVA does not increase the incidence of these fractures, it may be linked to a higher number of fractured vertebrae.
INTRODUCTION: Outlines the clinical burden of OVCFs and the existing controversy regarding the safety of PVA, identifying the need for a more granular analysis that distinguishes between clinical and radiological fractures.
PATIENTS AND METHODS: Describes the methodology of the systematic review and meta-analysis, covering literature search strategies, inclusion criteria, data extraction processes, and statistical models used.
RESULTS: Presents findings from 24 studies, showing no significant difference in clinical or radiological subsequent fracture rates between groups, but highlighting a higher number of fractured vertebrae in the PVA group.
DISCUSSIONS: Interprets the findings, suggesting that subsequent fractures are likely related to the natural progression of osteoporosis rather than the surgical procedure itself, while acknowledging limitations regarding study heterogeneity.
CONCLUSION: Reaffirms that PVA is a safe and feasible treatment that does not inherently increase subsequent fracture risk, though it remains associated with an increased count of fractured vertebrae.
REFERENCES: Provides a comprehensive list of the clinical studies and guidelines utilized to perform this meta-analysis.
Keywords
Osteoporotic vertebral compression fractures, OVCF, Percutaneous vertebral augmentation, PVA, Vertebroplasty, Kyphoplasty, Conservative treatment, Subsequent fractures, Meta-analysis, Systematic review, Bone health, Spinal deformity, Osteoporosis, Clinical complications, Radiological findings.
Frequently Asked Questions
What is the core focus of this research paper?
The paper focuses on evaluating the safety of percutaneous vertebral augmentation (PVA) in patients with osteoporotic vertebral compression fractures, specifically investigating whether the procedure increases the risk of subsequent adjacent fractures.
What are the primary themes discussed?
The central themes include the efficacy of minimally invasive spinal procedures, the natural progression of osteoporosis, the differentiation between clinical and radiological fracture assessment, and the comparative risks between surgical intervention and conservative management.
What is the main research question?
The study asks whether PVA is associated with a higher incidence of clinical or radiological subsequent adjacent fractures compared to conservative treatment.
Which scientific methods were employed in this study?
The authors conducted a systematic review and meta-analysis, aggregating data from multiple studies (RCTs and non-RCTs) and applying risk ratio calculations, heterogeneity tests (I2 statistic), and sensitivity/publication bias analyses.
What key findings are presented in the main body?
The meta-analysis found no significant difference in the incidence of clinical or radiological subsequent fractures between the PVA and control groups, although patients treated with PVA showed a higher number of fractured vertebrae.
Which terms best characterize this work?
Key terms include Osteoporotic vertebral compression fractures, PVA, meta-analysis, subsequent fractures, and spinal safety.
How does this study differ from previous meta-analyses?
This study distinguishes between clinical and radiological fractures and analyzes the number of fractured patients versus the number of fractured vertebrae, which the authors argue provides more persuasive and granular evidence than earlier reviews.
What is the "sandwich type" phenomenon mentioned in the study?
The authors discuss this as a specific pattern of multiple vertebral body fractures occurring after PVA, which may predispose the spine to additional adjacent fractures due to the altered biomechanics of the osteoporotic spine.
- Quote paper
- José Manuel Ortega Zufiría (Author), Rosa María Benítez Clemente (Author), Aida Yuste Sánchez (Author), 2020, Risk of Subsequent Adjacent Fractures after Vertebral Augmentation in the Treatment for Osteoporotic Vertebral Compression Fractures, Munich, GRIN Verlag, https://www.grin.com/document/948546
