Comparison between seven osteoporotic vertebral compression fractures treatments: A Systematic Review and Network Meta-Analysis

Abstract Vertebroplasty (VP), Kyphoplasty (KP), Spinejack system (SJ), Radiofrequency Kyphoplasty (RFK), Kiva system (Kiva), Sky kyphoplasty system (SK) and conservative treatment are widely used in the treatment of osteoporotic vertebral compression fractures (OVCFs). However, it is still unknown which is the best intervention. The aim of the current study was to evaluate the effectiveness and safety of VP, KP, SJ, RFK, Kiva, Sk and CT in the treatment of OVCFs. Methods Randomized controlled trials and cohort studies comparing VP, KP, SJ, RFK, Kiva, Sk or CT for the treatment of OVCFs were identified based on the databases including PubMed, the Cochrane Library, Web of Science, and Springer Link. A network meta-analysis was performed using STATA 15.1. Results A total of 56 studies with 6974 patients and seven interventions were included in this study. The results of the surface under the cumulative probability demonstrated that, Sk was the best intervention in decreasing VAS scores and recovering middle vertebral height, RFK was the best intervention in improving ODI scores and decreasing incidence of new fractures, SJ was the best intervention to restore kyphosis angle, and Kiva was the best intervention to reduce incidence of bone cement leakage. Cluster analysis showed that Sk was the preferable intervention based on the outcomes of VAS, ODI, middle vertebral height and kyphotic angle, and RFK was the preferable treatment in decreasing the incidence of adverse events. In our network meta-analysis, node-splitting analysis and loop inconsistency analysis showed no significant inconsistencies. Conclusions Sk may be the most effective treatment in relieving pain, improving the quality of life, and recovering vertebral body height and kyphotic angle, while RFK may be the safest intervention for OVCFs. However, considering the limitations of this study, more high-quality trials are needed in the future to confirm the current conclusion.