Risk factors for fractures secondary to percutaneous kyphoplasty: a meta-analysis.

BACKGROUND: Percutaneous kyphosis is improved on the basis of vertebroplasty, which can well restore the height of compressed vertebral body and reduce bone cement leakage. In recent years, it has been widely used in the treatment of osteoporotic vertebral compression fracture. However, it is often reported that there are recurrent fractures of the enhanced vertebral body and adjacent vertebral body after surgery, and the related factors affecting the recurrent fracture are still controversial. OBJECTIVE: To identify the risk factors for the fractures secondary to percutaneous kyphoplasty for treating osteoporotic vertebral compression fractures in the elderly by meta-analysis. METHODS: A comprehensive search was conducted for the studies published from January 2009 to April 2019 on the risk factors for secondary fractures after percutaneous kyphoplasty in the Cochrane Library, PubMed, CBM, CNKI and Wan Fang databases and manually as well. After the relevant data were extracted, statistical analysis was carried out with RevMan 5.3 software. RESULTS AND CONCLUSION: (1) The secondary fracture after percutaneous kyphoplasty for osteoporotic vertebral compression fracture was related to age [WMD=1.87, 95%CI (0.79, 2.95), P < 0.05], bone mineral density [WMD=-0.46, 95%CI (-0.61, -0.31 ), P < 0.05], bone cement leakage [OR=2.68, 95% Cl (2.11, 3.39), P < 0.000 01], correction of kyphosis angle after primary operation [WMD=2, 95% Cl (0.34, 3.88), P=0.02] and recovery rate of vertebral height after primary operation [WMD=5.25, 95% Cl (2.16, 8.34), P=0.000 9]. (2) The secondary fracture after percutaneous kyphoplasty for osteoporotic vertebral compression fracture was not related to sex [OR=0.83, 95% Cl (0.67, 1.02), P > 0.05], body mass index [WMD=-0.27, 95% Cl (-1.06, 0.51), P=0.49], cement volume [WMD=0.06, 95% Cl (-0.21, 0.32), P=0.68], surgical approach [OR=0.87, 95%CI (0.61, 1.25), P=0.46], primary fracture was thoracolumbar segment (T11-L.,) [OR=1.48, 95% Cl (0.93, 2.38), P=0.1]. (3) These results suggest that age, bone mineral density, bone cement leakage, correction of kyphosis angle after primary operation and recovery rate of vertebral height after primary operation may be the risk factors closely correlative to the secondary fracture after percutaneous kyphoplasty. There has not been enough evidence to support the associations between the secondary fracture and sex, body mass index, cement volume, surgical approach or thoracolumbar spine, and the above conclusions need to be studied and verified by more high quality literature in the future. [ABSTRACT FROM AUTHOR]