• Yuxiang Chen, Peng Yin, Yong Hai, Qingjun Su, and Jincai Yang.
• Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gong Ti Nan Road, Chaoyang District, Beijing, China.
• Pain Physician. 2021 Sep 1; 24 (6): E685-E692.

BackgroundThe management of pain after osteoporotic thoracolumbar burst fracture has not reached a treatment consensus. Percutaneous kyphoplasty has been shown to be efficient in reducing acute pain after burst fracture, although the topic remains highly controversial in this field.ObjectiveThis study aimed to conduct a systematic review of the current literature to evaluate the effectiveness and safety of percutaneous kyphoplasty on the treatment of osteoporotic thoracolumbar burst fracture.Study DesignA systematic review.SettingUniversity hospital.MethodsA comprehensive literature search was performed through PubMed, EMBASE, Web of Science, and Cochrane library without time restriction. Among the studies meeting the eligible criteria, any study in which percutaneous kyphoplasty was utilized alone in the treatment of osteoporotic thoracolumbar burst fracture was included in the current review. For radiographic outcome evaluation, vertebral height and kyphotic angle were analyzed. VAS (Visual Analog Scale) and ODI (Oswestry Disability Index) were utilized for clinical outcome evaluation. Complications such as cement leakage and adjacent vertebral fracture or relapse were also analyzed.ResultsIn total, 289 patients (338 vertebral bodies) were included in the 8 studies. Clinical outcomes indicated that patients achieved pain relief (VAS) from 6.8 preoperatively to 1.1 postoperatively, and improvement of quality of life (ODI) ranged from 87.0 ± 6.0% to 23.9 ± 4.4%. The radiological outcome indicated that anterior vertebral height restoration ranged from 20.1 ± 2.3 to 85.3 ± 10.6, and posterior vertebral height restoration ranged from 27.3 ± 1.7 to 83.3 ± 7.4. Kyphotic angle achieved correction ranged from 21.7 ± 7.8° preoperatively to 3.17° postoperatively. The main complications after PKP were cement leakage and adjacent vertebral fracture or relapse, which had an incidence of 7.7% -45.4% and 4.3% -74.1%, respectively.LimitationsDue to the good quality of the English publications, only English-language research searches were conducted, but they do not unduly affect our aggregate results impact. More prospective randomized controlled trials are needed to provide higher evidence for clinical practice.ConclusionsTo osteoporotic thoracolumbar burst fracture is absolutely not a contraindication to percutaneous kyphoplasty. Percutaneous kyphoplasty can obtain satisfactory effectiveness for the treatment of osteoporotic thoracolumbar burst fractures. Complications can be effectively decreased by meticulous evaluation, careful manipulation, and appropriate precautionary measures.

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