Korovessis Panagiotis, Syrimpeis Vasileios, Korovesis Alkis, Dimakopoulos Georgios
Spine and Orthopaedics Department, Olympion General Hospital, Patras, Greece.
Embedded Systems Design and Applications (ESDA) Laboratory, Department of Informatics and Telecommunications, University of the Peloponnese, Patras, Greece.
Front Surg. 2025 May 20;12:1594217. doi: 10.3389/fsurg.2025.1594217. eCollection 2025.
A Systematic Review and Meta-Analysis.
To compare the incidence of New Adjacent Vertebral Fractures (ANVFs) in elderly patients with Osteoporotic Vertebral Compression Fractures (OVCFs) undergoing either percutaneous vertebral augmentation-via Vertebroplasty (PVP) or Kyphoplasty (PKP)-or Conservative Treatment (CT). Additionally, this study aims to identify potential risk factors associated with ANVFs.
The incidence of ANVFs does not significantly differ between patients managed with CT and those treated with PVP or PKP.
While the optimal treatment for OVCFs remains debated, PVP and PKP offer immediate stabilization, pain relief, and may help correct vertebral body wedging with minimal complications. However, a review of the literature reveals a limited number of meta-analyses comparing CT with PVP/PKP regarding the incidence of ANVFs.
Following PRISMA guidelines, a systematic search was conducted across PubMed, Cochrane, Web of Science, Scopus and Science Direct to identify studies published between 2005 and 2024 comparing surgical treatment with CT for ANVFs incidence. Nine studies (five RCTs and four retrospective comparative case-control studies) involving 1,930 patients were included in the analysis.
In RCTs, the analysis indicated a significant difference ( < 0.05) in ANVFs incidence favoring the surgical group, with a Relative Risk (RR) of 0.66 (95% CI: 0.44-0.99; = 0.05); in retrospective studies, no statistically significant difference was found between the surgical and CT groups (OR = 0.87, 95% CI: 0.58-1.31; = 0.51). Differences in study parameters such as age, total number of participants, surgical approach (unilateral vs. bilateral), etc. were observed but they could not be accurately tested due to the limited number of studies.
This meta-analysis, for the selected RCTs, shows that vertebral augmentation is associated with a lower incidence of ANVFs compared to CT. On the other hand, in the retrospective studies group there was no significant difference in the incidence of ANVFs between the two treatment groups (CT vs. PKP/PVP). Variations in study parameters, such as patient demographics and surgical techniques, may have affected these results. Further high-quality studies are needed to better understand the long-term effects of different treatment strategies on the incidence of ANVFs.
PROSPERO (CRD420250509815).
系统评价与荟萃分析。
比较接受经皮椎体强化术（椎体成形术或后凸成形术）或保守治疗的老年骨质疏松性椎体压缩骨折患者新发相邻椎体骨折的发生率。此外，本研究旨在确定与新发相邻椎体骨折相关的潜在风险因素。
接受保守治疗的患者与接受椎体成形术或后凸成形术治疗的患者新发相邻椎体骨折的发生率无显著差异。
虽然骨质疏松性椎体压缩骨折的最佳治疗方法仍存在争议，但椎体成形术和后凸成形术可提供即时稳定、缓解疼痛，并可能有助于纠正椎体楔形变，且并发症最少。然而，文献综述显示，关于新发相邻椎体骨折发生率，比较保守治疗与椎体成形术/后凸成形术的荟萃分析数量有限。
按照PRISMA指南，在PubMed、Cochrane、科学引文索引、Scopus和Science Direct数据库中进行系统检索，以识别2005年至2024年期间发表的比较手术治疗与保守治疗新发相邻椎体骨折发生率的研究。纳入分析的有9项研究（5项随机对照试验和4项回顾性比较病例对照研究），共1930例患者。
在随机对照试验中，分析表明新发相邻椎体骨折发生率存在显著差异（<0.05），手术组更具优势，相对危险度为0.66（95%置信区间：0.44 - 0.99；P = 0.05）；在回顾性研究中，手术组和保守治疗组之间未发现统计学显著差异（比值比 = 0.87，95%置信区间：0.58 - 1.31；P = 0.51）。观察到研究参数（如年龄、参与者总数、手术入路（单侧与双侧）等）存在差异，但由于研究数量有限，无法进行准确检验。
对于所选随机对照试验，本荟萃分析表明，与保守治疗相比，椎体强化术与较低的新发相邻椎体骨折发生率相关。另一方面，在回顾性研究组中，两种治疗组（保守治疗与椎体成形术/后凸成形术）的新发相邻椎体骨折发生率无显著差异。研究参数的变化，如患者人口统计学特征和手术技术，可能影响了这些结果。需要进一步的高质量研究，以更好地了解不同治疗策略对新发相邻椎体骨折发生率的长期影响。
PROSPERO（CRD420250509815）
