Effectiveness and safety of angled percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures: a meta-analysis

Objective To investigate the effectiveness and safety of angled percutaneous vertebroplasty (PCVP) in the treatment of osteoporotic vertebral compression fractures (OVCF) based on the meta-analysis method. Methods Randomized controlled trials (RCT) or retrospective cohort studies (RCS) regarding PCVP and percutaneous vertebroplasty (PVP) for the treatment of OVCF were retrieved from PubMed, Cochrane Library, Web of Science, CNKI, and Wanfang Data from inception to September 13, 2023. The literature was screened according to inclusion and exclusion criteria, and a meta-analysis was performed. The outcome indicators included postoperative Visual Analogue Scale (VAS) score, postoperative Oswestry Disability Index (ODI) score, postoperative Cobb angle, postoperative vertebral height, operative time, intraoperative fluoroscopy times, bone cement injection volume, excellent and good rate of bone cement vertebral body distribution, bone cement leakage rate, and re-fracture rate. Results A total of 20 articles, including 12 RCT articles and 8 RCS articles, were included in this meta-analysis. Compared with the PVP group, the PCVP group had lower postoperative VAS scores (MD=-0.15, 95%CI, -0.18 to -0.11, P<0.000 01), lower postoperative ODI scores (MD=-1.63, 95%CI, -3.06 to -0.19, P=0.03), shorter operative time (MD= -7.15, 95%CI, -10.74 to -3.56, P<0.000 1), less intraoperative fluoroscopy times (MD=-3.40, 95%CI, -5.71 to -1.10, P=0.004), a higher excellent and good rate of bone cement vertebral body distribution (OR=5.84, 95%CI, 3.58 to 9.51, P<0.000 01), and a lower bone cement leakage rate (OR=0.31, 95%CI, 0.23 to 0.42, P<0.000 01). However, there were no significant differences in postoperative Cobb angle, postoperative vertebral height, bone cement injection volume, and re-fracture rate between the PCVP group and the PVP group (P>0.05). Conclusion Compared with PVP, PCVP has better effectiveness and safety in the treatment of OVCF, which can relieve pain, shorten operative time, reduce intraoperative fluoroscopy times and bone cement leakage rate, improve the excellent and good rate of bone cement vertebral body distribution, and enhance spinal function. If conditions permit, PCVP is recommended for the treatment of OVCF.