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29 August 2025
Extrapedicular vs Transpedicular Percutaneous Kyphoplasty for Osteoporotic Vertebral Compression Fractures: A Systematic Review and Meta-analysis
Fan Wu ,  Zhigao Wu ,  Xiang Shen ,  Wenjie Chen ,  Chizi Hao
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1 Department of Orthopedics, Geriatric Hospital Affiliated of Wuhan University of Science and Technology, Wuhan 430075, Hubei, China,
2 Hubei University of Chinese Medicine, Wuhan 430065, Hubei, China,
3 Department of Neurological Rehabilitation, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei, China,
BAS 2025 , 3(4), 43–53; https://doi.org/10.26689/bas.v3i4.11730
© 2025 by the Authors. Licensee Whioce Publishing, Singapore. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Background: Osteoporotic Vertebral Compression Fractures (OVCFs) are one of the most common health problems in the elderly population. Percutaneous kyphoplasty is a minimally invasive technique that has gained widespread recognition. Transpedicular and extrapedicular are two approaches for kyphoplasty. But over the last decade, the safety and effectiveness of two approaches have remained unclear, and there is still a lack of evaluation of their therapeutic effects. Objectives: To assess the efficacy and safety of the two approaches as a treatment for patients with OVCF. Methods: The study searched CENTRAL, MEDLINE, EMBASE, Chinese Biological Medicine Database, VIP Journals Database, Wan-fang database, CNKI and Chinese Evidence-Based Medicine Database from their inception to December 2020 in both English and Chinese. The study searched Chinese-language journals and conference proceedings. Randomised-controlled trials that compared any form of the transpedicular approach to any form of the extrapedicular approach control intervention in the treatment of osteoporotic vertebral compression fracture patients were included. Two review authors (Wu and Huang) independently determined the studies to be included in the review based on inclusion and exclusion criteria and the extracted data were analysed by RevMan 5.3, and the level of evidence was assessed by the GRADE system. Results: Six randomised controlled trials with a total sample size of 395 patients were included; all of them were from Asian countries. Meta-analysis showed that the extrapedicular approach kyphoplasty is superior to the transpedicular approach kyphoplasty for less radiology exposure time, less cement volume, and a lower leakage rate. But there is no difference between the extrapedicular approach kyphoplasty and the transpedicular approach kyphoplasty with postoperative VAS scores and ODI scores. Conclusion: Based on the evidence of 6 RCTs, the effectiveness of extrapedicular kyphoplasty for the treatment of osteoporotic vertebral compression fracture patients is suggestive. Extrapedicular kyphoplasty has less radiology exposure time, cement volume and a lower leakage rate than transpedicular kyphoplasty, and there is no significant difference in VAS and ODI after surgery. With the methodological quality and the small number of the included studies taken into consideration, furthermore high quality and large-scale randomized controlled trials are needed.

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