Lee Michael J, Dumonski Mark, Cahill Patrick, Stanley Tom, Park Daniel, Singh Kern
Rush University Medical Center, Chicago, IL, USA.
Spine (Phila Pa 1976). 2009 May 15;34(11):1228-32. doi: 10.1097/BRS.0b013e3181a3c742.
This study performs a meta-analysis to compare complication rates from vertebroplasty (VP) and kyphoplasty (KP).
Recently, the development of VP and balloon KP has been shown to provide symptomatic relief and restoration of sagittal alignment of vertebral compression fractures refractory to medical therapy. Complications in treatment of vertebral compression fractures are rare, however can be potentially devastating. Fortunately, clinical sequelae are rare; however, severe clinical complications from cement extravasation have been reported.
Using PubMed and Ovid, we performed a literature search for "kyphoplasty," "vertebroplasty," and "vertebral augmentation." This search was performed in December 2006. Case reports and reports not available in English were excluded. We categorized complications in 3 categories: (1) procedure-related complications, (2) medical complications, and (3) new vertebral fracture. Cement leakage, asymptomatic and symptomatic, and its locations were recorded. We performed a meta-analysis of complications of all studies. We then repeated the meta-analysis examining only prospective studies. We then used proportion analysis to determine statistical significance. We defined statistical significance as a P value less than 0.05.
We identified 121 reports of KP and/or VP that specifically addressed complications. Of these studies, 33 addressed KP and 82 addressed VP (6 reports addressed complications of both). There were 29 reports in which the data appeared to be collected prospectively. Of these, 9 addressed KP and 21 addressed VP.VP was found to have a significantly increased rate of procedure-related complications than KP in the analysis of all studies and only prospective studies. VP also appears to have a significantly higher rate of symptomatic and asymptomatic cement leakage than KP (P < 0.05). The incidence of medical complications was significantly higher in the KP procedure; however, this difference was not observed when analyzing only prospective studies. The incidence of new fracture was significantly higher in the VP procedure; however, this was not observed when analyzing only prospective studies.
VP and KP are 2 minimally invasive procedures that have been shown to be effective in the treatment of symptomatic vertebral compression fractures. Although the incidence of adverse events for both VP and KP are low, it appears that VP is associated with a statistically significant increased rate of procedure-related complications and cement extravasation (symptomatic and asymptomatic). Future prospective studies with large patient enrollment will be needed to further validate the finding of this meta-analysis.
本研究进行一项荟萃分析，以比较椎体成形术（VP）和后凸成形术（KP）的并发症发生率。
最近，已证实VP和球囊KP的发展可为药物治疗无效的椎体压缩骨折提供症状缓解和矢状位对线恢复。椎体压缩骨折治疗中的并发症很少见，但可能具有潜在的破坏性。幸运的是，临床后遗症很少见；然而，已有水泥渗漏导致严重临床并发症的报道。
利用PubMed和Ovid，我们对“后凸成形术”、“椎体成形术”和“椎体强化术”进行了文献检索。该检索于2006年12月进行。排除病例报告和非英文报告。我们将并发症分为3类：（1）与手术相关的并发症，（2）医疗并发症，（3）新的椎体骨折。记录有无症状的水泥渗漏及其位置。我们对所有研究的并发症进行了荟萃分析。然后仅对前瞻性研究重复进行荟萃分析。然后使用比例分析来确定统计学意义。我们将统计学意义定义为P值小于0.05。
我们确定了121篇专门论述并发症的KP和/或VP报告。在这些研究中，33篇论述KP，82篇论述VP（6篇论述两者的并发症）。有29篇报告的数据似乎是前瞻性收集的。其中，9篇论述KP，21篇论述VP。在所有研究和仅前瞻性研究的分析中，发现VP与手术相关并发症的发生率显著高于KP。VP似乎也有比KP显著更高的有症状和无症状水泥渗漏率（P < 0.05）。KP手术中医疗并发症的发生率显著更高；然而，仅分析前瞻性研究时未观察到这种差异。VP手术中新骨折的发生率显著更高；然而，仅分析前瞻性研究时未观察到这种情况。
VP和KP是两种已被证明对有症状的椎体压缩骨折治疗有效的微创手术。虽然VP和KP的不良事件发生率都很低，但似乎VP与手术相关并发症和水泥渗漏（有症状和无症状）的发生率在统计学上显著增加有关。未来需要纳入大量患者的前瞻性研究来进一步验证这项荟萃分析的结果。
