BACKGROUND CONTEXT

Prophylactic vertebroplasty (VP) is performed at the upper level of instrumentation during spinal fusion to reduce the risk of proximal junctional kyphosis (PJK), proximal junctional fracture (PJFx), and proximal junctional failure (PJF). This study investigated the effect of VP on patient outcomes after spinal fusion.

PURPOSE

The aim of this systematic review was to evaluate the effect of prophylactic VP on the incidence of PJK in patients with spinal fusion.

STUDY DESIGN/SETTING

Level III, systematic review without meta-analysis.

PATIENT SAMPLE

Adult patients undergoing spinal fusion with VP.

METHODS

A PRISMA-compliant systematic literature review was conducted using PubMed/MEDLINE, Cochrane, and Embase. Included studies were published in English between January 1, 2001, and May 27, 2021, and reported primary data on adult patients undergoing spinal fusion with VP. Studies were excluded for insufficient surgical details; treatment for vertebral compression fracture; and case series and/or reports with <5 patients. The Newcastle-Ottawa Scale was used to assess risk of bias. The primary outcome of interest was PJK. Other outcomes included PJFx, PJF, and adverse events (eg, cement extravasation). Data were expressed as descriptive statistics.

RESULTS

Eight studies with 685 total patients (VP: 293 [42.8%]; No VP: 392 (57.2%)) were included. Five studies were comparative and three were single-arm. PJK incidence was reported in five studies (three comparatives, two single-arm) and ranged from 7.9% to 46.4%; incidence was lower in patients with VP in two of three (66.7%) comparative studies, and equal in one of three (33.3%). PJFx was reported in five studies (four comparatives, one single-arm) and ranged from 0.0% to 39.3%; incidence was lower in the VP group in two of four (50.0%) comparative studies, equal in one of four (25.0%), and higher in one of four (25.0%). PJF was reported in five studies (three comparatives, two single-arm) and ranged from 0.0% to 39.3%; incidence was lower in the VP group in two of three (66.7%) comparative studies and equal in one of three (33.3%). Cement extravasation was reported by four studies and ranged from 0% (0/36) to 48.3% (57/118) in patients with prophylactic VP.

CONCLUSIONS

Evidence on whether prophylactic VP decreases the incidence of PJK, PJFx, and PJF after spinal fusion is inconclusive and conflicting. Additionally, the risk of cement extravasation following prophylactic VP could not be evaluated due to insufficient evidence. Further research is needed to determine whether VP has a significant impact on patient outcomes and risks.

中文翻译：

---

预防性椎体成形术预防脊柱融合术后近端连接并发症的疗效：系统评价

背景语境

预防性椎体成形术 (VP) 在脊柱融合期间在器械的上层进行，以降低近端交界处后凸畸形 (PJK)、近端交界处骨折 (PJFx) 和近端交界处衰竭 (PJF) 的风险。本研究调查了 VP 对脊柱融合术后患者预后的影响。

目的

本系统评价的目的是评估预防性 VP 对脊柱融合患者 PJK 发生率的影响。

研究设计/设置

III 级，没有荟萃分析的系统评价。

患者样本

接受 VP 脊柱融合术的成年患者。

方法

使用 PubMed/MEDLINE、Cochrane 和 Embase 进行了符合 PRISMA 标准的系统文献综述。纳入的研究于 2001 年 1 月 1 日至 2021 年 5 月 27 日期间以英文发表，并报告了接受 VP 脊柱融合术的成年患者的主要数据。研究因手术细节不足而被排除在外；椎体压缩性骨折的治疗；<5 例患者的病例系列和/或报告。纽卡斯尔-渥太华量表用于评估偏倚风险。感兴趣的主要结果是 PJK。其他结果包括 PJFx、PJF 和不良事件（例如，骨水泥外渗）。数据表示为描述性统计。

结果

纳入了 8 项研究，共有 685 名患者（VP：293 [42.8%]；无 VP：392（57.2%））。五项研究是比较性的，三项是单臂研究。五项研究（三项比较研究，两项单臂研究）报告了 PJK 发病率，范围从 7.9% 到 46.4%；在三项比较研究中的两项 (66.7%) 中，VP 患者的发病率较低，而在三项比较研究中的一项 (33.3%) 中，VP 患者的发病率较低。五项研究（四项比较，一项单臂）报告了 PJFx，范围从 0.0% 到 39.3%；在四项比较研究中的两项 (50.0%) 中，VP 组的发生率较低，在四项比较研究中的一项 (25.0%) 中相等，在四项比较研究中的一项 (25.0%) 中发生率较高。五项研究（三项比较，两项单臂）报告了 PJF，范围从 0.0% 到 39.3%；在三项比较研究中的两项 (66.7%) 中，VP 组的发生率较低，而在三项比较研究中的一项 (33.3%) 中，VP 组的发生率较低。

结论

关于预防性 VP 是否降低脊柱融合术后 PJK、PJFx 和 PJF 发生率的证据尚无定论且相互矛盾。此外，由于证据不足，无法评估预防性 VP 后骨水泥外渗的风险。需要进一步研究以确定 VP 是否对患者结果和风险有重大影响。