TY - JOUR
T1 - Risk of adjacent level fracture after percutaneous vertebroplasty and kyphoplasty vs natural history for the management of osteoporotic vertebral compression fractures
T2 - a network meta-analysis of randomized controlled trials
AU - Essibayi, Muhammed Amir
AU - Mortezaei, Ali
AU - Azzam, Ahmed Y.
AU - Bangash, Ali Haider
AU - Eraghi, Mohammad Mirahmadi
AU - Fluss, Rose
AU - Brook, Allan
AU - Altschul, David J.
AU - Yassari, Reza
AU - Chandra, Ronil V.
AU - Cancelliere, Nicole M.
AU - Pereira, Vitor Mendes
AU - Jennings, Jack W.
AU - Gilligan, Christopher J.
AU - Bono, Christopher M.
AU - Hirsch, Joshua A.
AU - Dmytriw, Adam A.
N1 - Publisher Copyright:
© The Author(s), under exclusive licence to European Society of Radiology 2024.
PY - 2024
Y1 - 2024
N2 - Objectives: Percutaneous vertebroplasty and kyphoplasty are common interventions for osteoporotic vertebral compression fractures. However, there is concern about an increased risk of adjacent-level fractures after treatment. This study aimed to compare the risk of adjacent-level fractures after vertebroplasty and kyphoplasty with the natural history after osteoporotic vertebral compression fractures. Materials and methods: A network meta-analysis of randomized controlled trials (RCTs) was conducted to evaluate the risk of adjacent-level fractures after vertebroplasty and kyphoplasty compared to the natural history after osteoporotic vertebral compression fractures. Frequentist network meta-analysis was conducted using the “netmeta” package, and heterogeneity was assessed using Q statistics. The pooled risk ratio (RR) and 95% confidence intervals (CI) were calculated using random effects. Results: Twenty-three RCTs with a total of 2838 patients were included in the analysis. The network meta-analysis showed comparable risks of adjacent-level fractures between vertebroplasty, kyphoplasty, and natural history after osteoporotic vertebral compression fractures with a mean follow-up of 21.2 (range: 3–49.4 months). The pooled RR for adjacent-level fractures after kyphoplasty compared to natural history was 1.35 (95% CI, 0.78–2.34, p = 0.23) and for vertebroplasty compared to natural history was 1.16 (95% CI, 0.62–2.14) p = 0.51. The risk of bias assessment showed a low to moderate risk of bias among included RCTs. Conclusion: There was no difference in the risk of adjacent-level fractures after vertebroplasty and kyphoplasty compared to natural history after osteoporotic vertebral compression fractures. The inclusion of a large patient number and network meta-analysis of RCTs serve evidence-based clinical practice. Clinical relevance statement: The risk of adjacent-level fracture following percutaneous vertebroplasty or kyphoplasty is similar to that observed in the natural history after osteoporotic vertebral compression fractures. Key Points: RCTs have examined the risk of adjacent-level fracture after intervention for osteoporotic vertebral compression fractures. There was no difference between vertebroplasty and kyphoplasty patients compared to the natural disease history for adjacent compression fractures. This is strong evidence that interventional treatments for these fractures do not increase the risk of adjacent fractures.
AB - Objectives: Percutaneous vertebroplasty and kyphoplasty are common interventions for osteoporotic vertebral compression fractures. However, there is concern about an increased risk of adjacent-level fractures after treatment. This study aimed to compare the risk of adjacent-level fractures after vertebroplasty and kyphoplasty with the natural history after osteoporotic vertebral compression fractures. Materials and methods: A network meta-analysis of randomized controlled trials (RCTs) was conducted to evaluate the risk of adjacent-level fractures after vertebroplasty and kyphoplasty compared to the natural history after osteoporotic vertebral compression fractures. Frequentist network meta-analysis was conducted using the “netmeta” package, and heterogeneity was assessed using Q statistics. The pooled risk ratio (RR) and 95% confidence intervals (CI) were calculated using random effects. Results: Twenty-three RCTs with a total of 2838 patients were included in the analysis. The network meta-analysis showed comparable risks of adjacent-level fractures between vertebroplasty, kyphoplasty, and natural history after osteoporotic vertebral compression fractures with a mean follow-up of 21.2 (range: 3–49.4 months). The pooled RR for adjacent-level fractures after kyphoplasty compared to natural history was 1.35 (95% CI, 0.78–2.34, p = 0.23) and for vertebroplasty compared to natural history was 1.16 (95% CI, 0.62–2.14) p = 0.51. The risk of bias assessment showed a low to moderate risk of bias among included RCTs. Conclusion: There was no difference in the risk of adjacent-level fractures after vertebroplasty and kyphoplasty compared to natural history after osteoporotic vertebral compression fractures. The inclusion of a large patient number and network meta-analysis of RCTs serve evidence-based clinical practice. Clinical relevance statement: The risk of adjacent-level fracture following percutaneous vertebroplasty or kyphoplasty is similar to that observed in the natural history after osteoporotic vertebral compression fractures. Key Points: RCTs have examined the risk of adjacent-level fracture after intervention for osteoporotic vertebral compression fractures. There was no difference between vertebroplasty and kyphoplasty patients compared to the natural disease history for adjacent compression fractures. This is strong evidence that interventional treatments for these fractures do not increase the risk of adjacent fractures.
KW - Compression fracture
KW - Kyphoplasty
KW - Osteoporotic fracture
KW - Vertebroplasty
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U2 - 10.1007/s00330-024-10807-3
DO - 10.1007/s00330-024-10807-3
M3 - Article
C2 - 38811388
AN - SCOPUS:85194813944
SN - 0938-7994
JO - European Radiology
JF - European Radiology
ER -