Vertebral Augmentation plus Pedicle Screw Fixation versus Vertebral Augmentation Alone in the Treatment of Osteoporotic Thoracolumbar Fractures: A Meta-Analysis

This meta-analysis was conducted to compare the efficacy and safety of vertebral augmentation (VA) plus pedicle screw fixation (PSF) with VA for treating osteoporotic thoracolumbar fractures (OTLFs). A comprehensive search was conducted in PubMed, Embase, Cochrane Library and China National Knowledge Infrastructure (CNKI) to identify studies comparing PSF+VA with VA for treating OTLF. The primary outcomes were operation time, blood loss, length of stay, visual analogue scale (VAS) score, Oswestry disability index (ODI), Cobb angle, anterior vertebral height (AVH), bone cement leakage, secondary fracture and other adverse events. Standardized mean deviation (SMD) and risk ratio(RR) with 95% confidence interval (CI) were calculated. Totally 14 studies met the entire inclusion criteria for our meta-analysis. The PSF+VA group was associated with significantly more operation time (SMD 4.41, 95% CI 3.32-5.51), blood loss (SMD=6.72, 95%CI 4.50 - 8.95), and length of stay (SMD=2.05, 95%CI 1.02 - 3.07). There was no significant VAS or ODI score difference at early follow-up. No significant difference was found in AVH between the two groups before two years. The remaining outcomes (VAS at six months and two years; ODI at six months and 1 year; Cobb angle at all follow-up periods; AVH at two years; bone cement leakage and secondary fracture) favored the PSF+VA group. PSF+VA was superior to VA for the VAS score, ODI, Cobb angle, AVH and complications, especially in the long-term follow-up. However, more operation time, blood loss and length of stay were the disadvantages for PSF+VA.