Whether the Unilateral Transverse Process-pedicle Approach has Advantages over the Traditional Transpedicle Approach: A Systematic review and Meta-analysis

Abstract

Purpose To summarize the literature and compare the advantages and disadvantages of the unilateral transverse process-pedicle approach (UTPA) and conventional transpedicular approach (CTPA) vertebral augmentation in the treatment of osteoporotic vertebral compression fractures (OVCF).

Methods A single researcher performed a systematic literature review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Online scientific databases were searched in September 2021 for English- and Chinese-language publications. A series of comparative studies were included, with UTPA as the main intervention and CTPA as the comparison indicator. A meta-analysis was performed for studies that reported clinical outcome indicators. The χ² was used to study heterogeneity between trials, and the I² statistic was calculated to estimate variation across studies.

Results A total of eight studies were included for meta-analysis, all of which were observational studies with mixed bias risk. There were 613 subjects in the UTPA group and 488 subjects in the CTPA group. The results of the meta-analysis showed that there was no difference between the UTPA group and the CTPA group in terms of visual analogue scale scores (p = 0.31), Oswestry Disability Index scores (p = 0.50), correction of kyphosis angle (p = 0.65), and the amount of bone cement (p = 0.13), but the UTPA group had a shorter operative time (p < 0.001), bone cement leakage rates (p = 0.02), and fluoroscopy times than the CTPA group (p < 0.001). Partial analysis results had a high risk of bias, and the most common source of bias was that there was high heterogeneity between studies, and the sensitivity can only be reduced by a random effect model, and some studies (four items) did not clearly describe the confounders that they controlled.

Conclusion The limited evidence obtained in this study proves that the new puncture method does not have more advantages than the traditional technique, so it is no longer meaningful to continue to obsess over the impact of the puncture method on surgical outcome.

Zusammenfassung

Zweck Um die Literatur zusammenzufassen und die Vor- und Nachteile der unilateralen Transversal-Prozess-Pedikel-Annäherung (UTPA) und der konventionellen transpedikulären Ansatz (CTPA)-Wirbelaugmentation bei der Behandlung von osteoporotischen vertebralen Kompressionsfrakturen (OVCF) zu vergleichen.

Methoden Ein einzelner Forscher führte eine systematische Literaturrecherche unter Verwendung der Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-Richtlinien durch. Wissenschaftliche Online-Datenbanken wurden im September 2021 nach englisch- und chinesischsprachigen Publikationen durchsucht. Eine Reihe von Vergleichsstudien wurde eingeschlossen, mit UTPA als Hauptintervention und CTPA als Vergleichsindikator. Für Studien, die klinische Ergebnisindikatoren berichteten, wurde eine Metaanalyse durchgeführt. χ² wurde verwendet, um die Heterogenität zwischen den Studien zu untersuchen, und die I²-Statistik wurde berechnet, um die Variation zwischen den Studien abzuschätzen.

Ergebnisse Insgesamt wurden acht Studien in die Metaanalyse eingeschlossen, die alle Beobachtungsstudien mit gemischtem Bias-Risiko waren. 613 Probanden in der UTPA-Gruppe und 488 Probanden in der CTPA-Gruppe. Die Ergebnisse der Metaanalyse zeigten, dass es keinen Unterschied zwischen der UTPA-Gruppe und der CTPA-Gruppe in Bezug auf VAS-Werte (p = 0.31), ODI-Werte (p = 0.50), Korrektur des Kyphosewinkels (p = 0.65) und die Menge an Knochenzement (p = 0.13), aber die UTPA-Gruppe hatte weniger Operationszeit (p < 0.001), Knochenzementaustrittsraten (p = 0.02) und Durchleuchtungszeiten als die CTPA-Gruppe (p < 0.001). Teilanalyseergebnisse wiesen ein hohes Risiko für Bias auf, und die häufigste Quelle für Bias war, dass zwischen den Studien eine hohe Heterogenität bestand und die Sensitivität nur durch das Zufallseffektmodell verringert werden kann und einige Studien (vier Elemente) dies nicht klar beschreiben Confounder, die sie kontrollierten.

Schlussfolgerungen Die in dieser Studie erhaltenen begrenzten Beweise belegen, dass die neue Punktionsmethode nicht mehr Vorteile als die traditionelle Technik hat, sodass es nicht länger sinnvoll ist, sich weiterhin mit den Auswirkungen der Punktionsmethode auf das Operationsergebnis zu befassen.

Keywords

unilateral transverse process-pedicle approach - vertebral augmentation - osteoporotic vertebral compression fractures - Systematic review - meta-analysis

Schlüsselwörter

einseitiger Querfortsatz-Pedikel-Ansatz - Wirbel Augmentation - osteoporotische Wirbelkörperkompressionsfrakturen - Systematische Überprüfung - Meta-Analyse

Publikationsverlauf

Eingereicht: 27. Dezember 2021

Angenommen nach Revision: 15. Februar 2022

Artikel online veröffentlicht:
04. April 2022

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