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Risk of subsequent adjacent fractures after vertebral augmentation: A systematic review.

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Title: Risk of subsequent adjacent fractures after vertebral augmentation: A systematic review.
Alternate Title: Riesgo de fracturas adyacentes en el tratamiento de las fracturas de compresión vertebral: Metaanálisis.
Authors: Ortega-Zufiría, José M.1 fuencarral108@hotmail.com, Sierra-Rodríguez, Mario1, López-Ramirez, Yaiza1, Bernal-Piñeiro, Jorge1, Silva-Mascaró, Daniel1, Tamarit-Degenhardt, Martin1
Source: Revista Mexicana de Neurociencia. May/Jun2021, Vol. 22 Issue 3, p89-95. 7p.
Subjects: VERTEBRAL fractures, RADIOLOGY, CLINICAL trials, CONFIDENCE intervals, COMPUTED tomography
Abstract (English): Background: The incidence of vertebral fractures is high and the new treatment options developed in recent years represent a significant improvement, although they are not without complications. Objectives: The aim of this study was to investigate whether percutaneous vertebral augmentation (PVA) was associated with clinical and radiological subsequent adjacent fractures. Methods: A systematic review and meta-analysis was performed searching on PubMed, EMBASE, Cochrane library, Google Scholar, Web of Science, and ClinicalTrial.gov from the establishment of the database to January 2020. Eligible studies assessing the subsequent adjacent fractures after PVA compared with conservative treatment (CT) were incorporated. The pooled risk ratio (RR) with its 95% confidence intervals (95% CI) was used. Heterogeneity, sensitivity, and publication bias analyses were performed. Results: Twenty-four studies were considered eligible and were included finally. 20/421 patients (4.75%) had clinical subsequent adjacent fractures from the PVA group, and 25/359 patients (6.96%) had from the CT group, and 46/440 patients (10.45%) from the PVA group and 36/444 patients (8.10%) from the CT group had radiological subsequent adjacent fractures. There both had no significant difference between two groups (RR = 0.67, 95%CI: [0.38, 1.19], p = 0.17)/(RR = 1.13, 95% CI: [0.75, 1.70], p = 0.576). However, in fractured vertebrae, number in the PVA group was more than that in the CT group (RR=1.41, 95%CI: [1.03, 1.93], p = 0.03). Conclusion: Collectively, currently available literature provides data showed that PVA did not increase the incidence for subsequent adjacent fractures, no matter it was clinical or radiological fracture. However, PVA may increase the number of fractured vertebrae. [ABSTRACT FROM AUTHOR]
Abstract (Spanish): Antecedentes: La incidencia de fracturas vertebrales es elevada y las nuevas opciones de tratamiento desarrolladas en los últimos años suponen una mejoría importante, aunque no se encuentran exentas de complicaciones. Objetivos: El objetivo de este estudio fue investigar si el tratamiento vertebral percutáneo se asoció con fracturas en los niveles adyacentes, tanto clínicas como radiológicas, en los controles posteriores. Métodos: Se realizó una revisión sistemática y un metanálisis buscando en PubMed, EMBASE, la biblioteca Cochrane, Google Scholar, Web of Science y ClinicalTrial.gov desde el establecimiento de la base de datos hasta enero de 2020. Se eligieron estudios elegibles que evalúan las fracturas adyacentes posteriores después de PVA en comparación con tratamiento conservador (CT). Se utilizó la razón de riesgo (RR), agrupada con sus intervalos de confianza del 95% (IC del 95%). Se realizaron análisis de heterogeneidad, de sensibilidad y de sesgo de publicación. Resultados: Se consideraron elegibles 24 estudio, que se incluyeron finalmente. Del total de pacientes estudiados, 20/421 pacientes (4.75%) tuvieron fracturas adyacentes clínicas posteriores del grupo PVA, y 25/359 pacientes (6,96%) tuvieron del grupo CT, y 46/440 pacientes (10.45%) del grupo PVA y 36/444 pacientes (8.10 %) del grupo CT tenía fracturas adyacentes radiológicas posteriores. No existieron diferencias significativas entre los dos grupos (RR = 0.67, IC 95%: [0.38, 1.19], p = 0.17) / (RR = 1.13, IC 95%: [0.75, 1.70], p = 0.576). Sin embargo, en las vértebras fracturadas, el número en el grupo PVA fue mayor que en el grupo CT (RR = 1.41, IC 95%: [1.03, 1.93], p = 0.03). Conclusión: Desde un punto de vista general, la literatura actualmente disponible proporciona datos que muestran que el PVA no aumentó la incidencia de fracturas adyacentes posteriores, sin importar si fue una fractura clínica o radiológica. Pero el PVA puede aumentar el número de vértebras fracturadas. [ABSTRACT FROM AUTHOR]
Copyright of Revista Mexicana de Neurociencia is the property of Academia Mexicana de Neurologia and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Risk of subsequent adjacent fractures after vertebral augmentation: A systematic review.
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  Data: Riesgo de fracturas adyacentes en el tratamiento de las fracturas de compresión vertebral: Metaanálisis.
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  Data: <searchLink fieldCode="JN" term="%22Revista+Mexicana+de+Neurociencia%22">Revista Mexicana de Neurociencia</searchLink>. May/Jun2021, Vol. 22 Issue 3, p89-95. 7p.
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  Data: <searchLink fieldCode="DE" term="%22VERTEBRAL+fractures%22">VERTEBRAL fractures</searchLink><br /><searchLink fieldCode="DE" term="%22RADIOLOGY%22">RADIOLOGY</searchLink><br /><searchLink fieldCode="DE" term="%22CLINICAL+trials%22">CLINICAL trials</searchLink><br /><searchLink fieldCode="DE" term="%22CONFIDENCE+intervals%22">CONFIDENCE intervals</searchLink><br /><searchLink fieldCode="DE" term="%22COMPUTED+tomography%22">COMPUTED tomography</searchLink>
– Name: Abstract
  Label: Abstract (English)
  Group: Ab
  Data: Background: The incidence of vertebral fractures is high and the new treatment options developed in recent years represent a significant improvement, although they are not without complications. Objectives: The aim of this study was to investigate whether percutaneous vertebral augmentation (PVA) was associated with clinical and radiological subsequent adjacent fractures. Methods: A systematic review and meta-analysis was performed searching on PubMed, EMBASE, Cochrane library, Google Scholar, Web of Science, and ClinicalTrial.gov from the establishment of the database to January 2020. Eligible studies assessing the subsequent adjacent fractures after PVA compared with conservative treatment (CT) were incorporated. The pooled risk ratio (RR) with its 95% confidence intervals (95% CI) was used. Heterogeneity, sensitivity, and publication bias analyses were performed. Results: Twenty-four studies were considered eligible and were included finally. 20/421 patients (4.75%) had clinical subsequent adjacent fractures from the PVA group, and 25/359 patients (6.96%) had from the CT group, and 46/440 patients (10.45%) from the PVA group and 36/444 patients (8.10%) from the CT group had radiological subsequent adjacent fractures. There both had no significant difference between two groups (RR = 0.67, 95%CI: [0.38, 1.19], p = 0.17)/(RR = 1.13, 95% CI: [0.75, 1.70], p = 0.576). However, in fractured vertebrae, number in the PVA group was more than that in the CT group (RR=1.41, 95%CI: [1.03, 1.93], p = 0.03). Conclusion: Collectively, currently available literature provides data showed that PVA did not increase the incidence for subsequent adjacent fractures, no matter it was clinical or radiological fracture. However, PVA may increase the number of fractured vertebrae. [ABSTRACT FROM AUTHOR]
– Name: Abstract
  Label: Abstract (Spanish)
  Group: Ab
  Data: Antecedentes: La incidencia de fracturas vertebrales es elevada y las nuevas opciones de tratamiento desarrolladas en los últimos años suponen una mejoría importante, aunque no se encuentran exentas de complicaciones. Objetivos: El objetivo de este estudio fue investigar si el tratamiento vertebral percutáneo se asoció con fracturas en los niveles adyacentes, tanto clínicas como radiológicas, en los controles posteriores. Métodos: Se realizó una revisión sistemática y un metanálisis buscando en PubMed, EMBASE, la biblioteca Cochrane, Google Scholar, Web of Science y ClinicalTrial.gov desde el establecimiento de la base de datos hasta enero de 2020. Se eligieron estudios elegibles que evalúan las fracturas adyacentes posteriores después de PVA en comparación con tratamiento conservador (CT). Se utilizó la razón de riesgo (RR), agrupada con sus intervalos de confianza del 95% (IC del 95%). Se realizaron análisis de heterogeneidad, de sensibilidad y de sesgo de publicación. Resultados: Se consideraron elegibles 24 estudio, que se incluyeron finalmente. Del total de pacientes estudiados, 20/421 pacientes (4.75%) tuvieron fracturas adyacentes clínicas posteriores del grupo PVA, y 25/359 pacientes (6,96%) tuvieron del grupo CT, y 46/440 pacientes (10.45%) del grupo PVA y 36/444 pacientes (8.10 %) del grupo CT tenía fracturas adyacentes radiológicas posteriores. No existieron diferencias significativas entre los dos grupos (RR = 0.67, IC 95%: [0.38, 1.19], p = 0.17) / (RR = 1.13, IC 95%: [0.75, 1.70], p = 0.576). Sin embargo, en las vértebras fracturadas, el número en el grupo PVA fue mayor que en el grupo CT (RR = 1.41, IC 95%: [1.03, 1.93], p = 0.03). Conclusión: Desde un punto de vista general, la literatura actualmente disponible proporciona datos que muestran que el PVA no aumentó la incidencia de fracturas adyacentes posteriores, sin importar si fue una fractura clínica o radiológica. Pero el PVA puede aumentar el número de vértebras fracturadas. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
  Label:
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  Data: <i>Copyright of Revista Mexicana de Neurociencia is the property of Academia Mexicana de Neurologia and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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