Unilateral extrapedicular versus unilateral and bilateral transpedicular approaches in percutaneous vertebral...

The present meta-analysis aims to perform a comprehensive, evidence-based comparison of the effectiveness and safety of the unilateral extrapedicular approach (UEA) percutaneous vertebral augmentation and transpedicular approach percutaneous vertebral augmentation for osteoporotic vertebral compression fractures (OVCFs).

Publications indexed up to May 2025 were interrogated across Cochrane Library, Web of Science, PubMed, Embase, and SpringerLink using the combined keywords "unilateral extrapedicular approach", "transpedicular approach", "percutaneous vertebral augmentation", "percutaneous vertebroplasty", "percutaneous kyphoplasty", and "osteoporotic vertebral compression fractures". Mean difference (MD) and risk difference (RD) served as summary metrics, each expressed with 95% confidence intervals (CIs).

Eight clinical trials involving 830 patients were included. The UEA significantly shortened operative time (MD=-4.26; 95% CI:-6.15 ~ -2.37; p<0.00001), compared to unilateral transpedicular approach (UTA), while no statistically significant differences were observed in cement leakage (RD:-0.01; 95% CI:-0.09 ~ 0.07; p=0.88), cement injection volume (MD=0.20; 95% CI:-0.02 ~ 0.41; p=0.07), or intraoperative fluoroscopy times (MD=-1.15; 95% CI:-3.62 ~ 1.32; p=0.36). Notably, UEA demonstrated significant advantages over bilateral transpedicular approach (BPA) in reducing cement leakage rate (RD:-0.08; 95% CI:-0.14 ~ -0.02; p=0.01), decreasing cement injection volume (MD=-1.51; 95% CI:-2.98 ~ -0.04; p=0.04), shortening operative time (MD=-9.64; 95% CI:-13.25 ~ -6.04; p<0.00001), and minimizing intraoperative fluoroscopy times (MD=-8.12; 95% CI:-12.36 ~ -3.88; p=0.0002). However, no significant intergroup differences were found between UEA and BPA in postoperative Visual Analog Scale (VAS) (MD=-0.04; 95% CI:-0.24 ~ 0.17; p=0.73), postoperative Cobb angle (MD=-0.37; 95% CI:-0.54 ~ 1.28; p=0.42) or Oswestry Disability Index (ODI) (MD=-0.54; 95% CI:-2.81 ~ 1.72; p=0.64).

In the management of OVCFs, UEA offers shorter operative time compared with UTA. Additionally, UEA shows remarkable superiority over BPA in cement injection volume, cement leakage rate, intraoperative fluoroscopy frequency and operative time.