Optimal management for osteoporotic vertebral compression fractures: a network meta-analysis

Area of Science:

• Orthopedics
• Spine Surgery
• Geriatric Medicine

Background:

• Optimal management for osteoporotic vertebral compression fractures (OVCFs) is debated.
• Network meta-analysis (NMA) is used to compare third-generation percutaneous vertebral augmentation (TVA), percutaneous kyphoplasty (PKP), percutaneous vertebroplasty (PVP), and non-surgical management (NSM).

Purpose of the Study:

• To evaluate the relative efficacy and safety of TVA, PKP, PVP, and NSM for OVCFs.
• To compare outcomes including pain, function, quality of life, and adverse events.

Main Methods:

• Systematic literature search of major databases (PubMed, Embase, Cochrane, Web of Science) up to February 1, 2025.
• Inclusion of 46 studies (23 RCTs, 23 cohort studies; n=5,660) comparing at least two interventions.
• Primary outcomes: Visual Analog Scale (VAS) for pain, Oswestry Disability Index (ODI) for function, EQ-5D for quality of life, anterior vertebral body height (AVB). Secondary outcomes: adjacent vertebral fracture (AVF), bone cement leakage (BCL).

Main Results:

• TVA and PKP showed greater VAS reduction than NSM short-term and long-term.
• TVA improved ODI more than NSM short-term and long-term; PKP improved ODI short-term but was inferior to TVA long-term.
• All surgical methods improved quality of life over NSM. TVA and PKP restored AVB better than NSM. PVP had higher BCL risk. NSM had the lowest AVF probability.

Conclusions:

• Third-generation TVA appears superior to PVP, PKP, and NSM in improving pain, function, quality of life, and safety for OVCF patients.
• PKP offers the greatest long-term preservation of AVB.
• High-quality randomized trials with extended follow-up are needed to confirm these findings.