Efficacy And Safety Of Two Types Of Vertebral Augmentation For Kummell’s Disease:A Meta-analysis

Objective（s）: The clinical efficacy and safety of bone filling mesh container（BFMC）and percutaneous kyphoplasty（PKP）for the treatment of kummell’s disease（KD）were analyzed through a Meta-analysis to provide evidence-based medical support for clinical practitioners in their choice of treatment options.Methods: All domestic and international literature and data on BFMC and PKP for the treatment of KD were screened through computer searches of domestic and international databases such as CNKI,Wanfang,VIP,China Biomedical Literature Database（CBM）,Pub Med,Embase,Cochrane library,Web of Science,from the establishment of the database to March 2022,while references and domestic and international clinical trial registries were searched manually.Two researchers independently used Noteexpress software to remove duplicates,browse titles and abstracts for preliminary screening,and re-screen after intensive reading of the full text.Unmatched literature was excluded according to the inclusion criteria.The data were then extracted according to established tables,quality assessed using the Cochrane Risk of Bias Assessment Tool and the MINORS scale,and finally analyzed statistically using Review Manager 5.4 software.Results: Eight Chinese and English literature,four randomized controlled trials（RCTs）,and four non-randomized controlled trials（NON-RCTs）involving a total of400 patients with KD were finally screened,of whom 187 were treated with bone filling mesh container and 213 with percutaneous kyphoplasty.Meta-analysis results: P>0.05 for both groups with the consistency of baseline data in terms of preoperative pain degree and vertebral compression degree.There was no significant difference between the two groups in terms of postoperative clinical outcome [VAS score,ODI index（short-term,long-term）] and imaging indices（Cobb angle,height or relative height of the anterior vertebral body margin）,and the amount of bone cement infused,with P>0.05.In terms of operative time,at unilateral puncture,WMD=-5.73,95% CI（-8.02,-3.44）,P<0.00001,the BFMC group was superior to the PKP group.In terms of the number of fluoroscopies,WMD=-7.99,95% CI（-15.70,-0.27）,p=0.04,the BFMC group was superior to the PKP group.In terms of bone cement leakage rate,OR=0.17,95% CI（0.08,0.33）,P<0.00001,the BFMC group was significantly better than the PKP group.Conclusion（s）: In the treatment of KD,both BFMC and PKP can better relieve pain and restore the patient’s body movement function,both can more satisfactorily restore the height of the injured vertebrae and correct kyphosis,and achieve the purpose of improving the quality of life of KD patients.However,BFMC has advantages over PKP in terms of safety in terms of bone cement leakage rate,procedure time（unilateral puncture）,and the number of fluoroscopic views.Therefore,excluding the price factor,bone filling mesh container can be the first choice when faced with a patient with KD who requires vertebral augmentation or poor basic tolerance.