1. 2019;22;15-28Unilateral Versus Bilateral Balloon Kyphoplasty for Osteoporotic Vertebral Compression Fractures: A Systematic Review of Overlapping Meta-analyses
   Systematic Review
   Cui Zhiyong, MD, Tian Yun, MD, Feng Hui, MD, Yang Zhongwei, MD, and Liu Zhaorui, MD.

BACKGROUND: There have been many meta-analyses and systematic reviews that have discussed the differences between unilateral and bilateral balloon kyphoplasty. However, their conclusions regarding the efficacy and safety of bilateral balloon kyphoplasty in the treatment of osteoporotic vertebral compression fractures (OVCFs) are discordant.

OBJECTIVE: We attempted to select the best evidence review to determine the differences between unilateral and bilateral balloon kyphoplasty, and we wanted to determine the best treatment approach for OVCFs.

STUDY DESIGN: A systematic review of overlapping meta-analyses

SETTING: The electronic databases of PubMed, Embase and The Cochrane Library were searched. The search extended through Sept. 30, 2017. Moreover, we manually searched the last 10 years of conference reports and papers from the Peking University Health Science Library and consulted 2 experts in the field for any additional relevant information.

METHODS: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Statement and used “A Measurement Tool to Assess Systematic Reviews” (AMTASR) and the Oxford Levels of Evidence to assess the methodological quality of the studies. We applied the Jadad decision algorithm to select the best evidence review.

RESULTS: Seven meta-analyses were included in this systematic review. The AMTASR scores of the studies ranged from 4 to 9, with an average of 6. Finally, Sun H et al was shown to represent the best evidence study. Sun H et al proposed that the unilateral kyphoplasty required less surgical time and consumed less cement, reduced cement leakage, and improved short-term general health compared with that of bilateral kyphoplasty.

LIMITATIONS: The AMTASR scores indicated that some of the included studies were of low quality. In addition, not all of the studies used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) level. When used, the GRADE level indicated that most of the results consisted of studies of low quality.

CONCLUSIONS: Unilateral kyphoplasty reduces the operative time, cement volume, and cement leakage rate compared with bilateral kyphoplasty. Therefore, we conclude that unilateral kyphoplasty is more advantageous, effective and safe, compared to bilateral kyphoplasty for the treatment of OVCFs.

KEY WORDS: Osteoporotic vertebral compression fracture, kyphoplasty, unilateral, bilateral, unipedicular, bipedicular, systematic review