Pedicle Screw Fixation Plus Cement Augmentation or Cement augmentation Only for Osteoporotic Vertebral Compression Fracture: A Systematic Review and Meta-Analysis.

BACKGROUND

Osteoporotic vertebral compression fractures (OVCFs) are common fractures and pedicle screw system gains dissatisfactory results since bone mass loss. Cement augmentation (CA) is the most applied surgery modality for OVCFs but with shortcomings. Pedicle screw fixation plus CA (PSF + CA) has been reported superior to CA. This study aims to investigate the impact of PSF + CA on OVCFs.

METHODS

We approached databases of PubMed, Europe PMC, Web of Science, CENTRAL, and Embase for studies published up to November 2023. Clinical outcomes (hospital stay, blood loss, cement volume, cement leakage, secondary fracture), radiological outcomes (local kyphotic angle and anterior vertebral height), and subjective outcomes (visual analog scale and Oswestry Disability Index) were extracted. We tested the sensitivity and publication bias, rated evidence, calculated total effect sizes with prediction intervals, and explained heterogeneity.

RESULTS

Six studies were included with 255/339 patients in the PSF + CA group/CA-only group. The result is as follows: the PSF + CA group showed better in local kyphotic angle; anterior vertebral height claimed insufficient support favoring PSF + CA. The CA-only group showed better clinical outcome of hospital stay, blood loss, and operative time. Cement volume and cement leakage difference were not significant. Secondary fractures occurred more in the CA-only group. Visual analog scale scores favored the PSF + CA group, and Oswestry Disability Index results were too inaccurate to conclude.

CONCLUSIONS

PSF + CA and CA-only procedures achieved efficient clinical outcomes in OVCFs. PSF + CA showed better strength in deformity correction and long-term maintenance, less strength in incidence of secondary fracture, and more pain relief at the cost of length of hospital stay, blood loss, and operative time.