Percutaneous curved vertebroplasty versus unipedicular vertebroplasty for osteoporotic vertebral compression fractures: a systematic review and meta-analysis.

To evaluate the use of percutaneous curved vertebroplasty (PCVP) and unipedicular vertebroplasty (UVP) for the treatment of osteoporotic vertebral compression fractures (OVCFs) through a systematic review and meta-analysis of the available literature. A systematic review of the scientific literature was conducted. Three randomized controlled trials and one retrospective study were included. Our outcomes of interest included injected cement volume, postoperative visual analog scale (VAS) scores, operative time, and cement leakage rate. Risk of bias tables were generated to determine the quality of each article. Four studies with 302 patients were included in the study. There were 142 (47.02%) patients in the PCVP group and 160 (52.98%) patients in the UVP group. PCVP was associated with significantly higher volumes of injected cement than UVP (MD: 1.20, CI: [0.27; 2.12], p = 0.01). Despite showing a strong trend in favor of PCVP, the meta-analysis did not report its superiority over UVP in terms of VAS (MD: -0.69, CI: [-1.66; 0.28], p = 0.16) and cement leakage rates (OR: 1.65, CI: [0.24; 1.75], p = 0.26), likely due to a few number of studies. Additionally, both the procedures had comparable mean operative times (MD: 0.20, CI: [-1.62; 2.03], p = 0.83), possibly due to overlapping procedure protocols. PCVP reported a significantly higher volume of the injected cement compared to UVP for the management of OVCFs. While trends favoring PCVP in postoperative outcomes were observed, the limited number of studies warrants further high-quality investigations, particularly randomized controlled trials with long-term outcomes, to establish the definitive superiority of either technique.