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The Incidence of Adjacent Level Fracture After Percutaneous Vertebroplasty and Kyphoplasty Compared to Natural History: A Network Meta-Analysis of Randomized Controlled Trials

Friday, May 3, 2024

Presenting Author(s)

Muhammed Amir Essibayi, MD (he/him/his)

Postdoctoral Research Fellow
Department of Neurosurgery & Montefiore Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine
Bronx, NY, US

Co-Author(s)

DA

David Altschul, n/a

Associate Professor
Department of Neurosurgery & Montefiore Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine
Bronx, New York, United States
aA

ahmed Y Azzam, n/a

Research collaborator
Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA, United States
AB

Ali Haidar Bangash, n/a

Research collaborator
Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA, United States
CB

Christopher M. Bono, n/a

Professor
Department of Orthopedics, Massachusetts General Hospital & Brigham and Women’s Hospital, Harvard Medical School, Boston MA, USA, United States
AB

Allan Brook, n/a

Professor
Department of Neuroradiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
Armonk, New York, United States
Nc

Nicole cancelliere, n/a

Attending
Neurovascular Centre, Departments of Medical Imaging & Neurosurgery, St. Michael’s Hospital, University of Toronto, Toronto ON, Canada, United States
RC

Ronil V Chandra, n/a

Professor
Department of Interventional Neuroradiology, Monash Health, Clayton, Victoria, Australia., United States
AD

Adam Dmytriw, n/a

Assistant Professor
Neurovascular Centre, Departments of Medical Imaging & Neurosurgery, St. Michael’s Hospital, University of Toronto, Toronto ON, Canada
Boston, Massachusetts, United States
MS

Mohammad Sana, n/a

Research collaborator
Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA, United States
RF

Rose Fluss, n/a

Resident
Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
Bronx, New York, United States
CG

Christopher J. Gilligan, n/a

Professor
Division of Pain Medicine, Department of Anesthesiology, Massachusetts General Hospital & Brigham and Women’s Hospital, Harvard Medical School, Boston MA, USA, United States
JH

Joshua Hirsch, n/a

Professor
Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women’s Hospital, Harvard Medical School, Boston MA, USA, United States
JJ

Jack W. Jennings, n/a

Professor
Musculoskeletal Radiology, Mallinckrodt Institute of Radiology, Washington University St. Louis School of Medicine, St. Louis, MO, United States
AM

Ali Mortezaei, n/a

Research collaborator
Montefiore-Einstein Cerebrovascular Research Lab, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA, United States
VP

Vitor Mendes Pereira, n/a

Professor
Neurovascular Centre, Departments of Medical Imaging & Neurosurgery, St. Michael’s Hospital, University of Toronto, Toronto ON, Canada, United States
RY

Reza Yassari, MD

Professor
Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
Bronx, New York, United States

Introduction: Percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) are common interventions for osteoporotic vertebral compression fractures (OVCF). However, there is concern about an increased risk of adjacent level fractures (ALF) after treatment. This study aimed to compare the risk of ALF after PVP and PKP with the natural history after OVCF.

Methods: A systematic review and network meta-analysis of randomized controlled trials (RCTs) were conducted to evaluate the risk of ALF after PVP and PKP compared to the natural history after OCVF. The Cochrane risk-of-bias tool for randomized trials (RoB 2) was used to assess the risk of bias among included RCTs. Frequentist network meta-analysis was conducted using the "netmeta" package, and heterogeneity was assessed using Q-statistics. The pooled relative risk (RR) and 95% confidence intervals (CI) were calculated using random-effects.

Results: Twenty-six RCTs with a total of 3281 patients were included in the analysis. The network meta-analysis showed comparable risks of ALF between PVP, PKP, and natural history after OCVF with a mean follow- up of 20.7 months (range: 1-49.7 months). The pooled RR for ALF after PKP compared to natural history was 1.22 (95% CI, 0.72 – 2.08), and for PVP compared to natural history was 1.35 (95% CI, 0.81 – 2.26). The risk of bias assessment showed a low to moderate risk of bias among included RCTs.

Conclusion : There was no difference in the risk of ALF after PVP and PKP compared to natural history after OCVF. The inclusion of a large number of patients and network meta-analysis of RCTs should help serve evidence-based clinical practice.
and PVP groups.