Unilateral extrapedicular versus unilateral and bilateral transpedicular approaches in percutaneous vertebral augmentation for osteoporotic vertebral compression fractures: A meta-analysis

Abstract

Objectives: The present meta-analysis aims to perform a comprehensive, evidence-based comparison of the effectiveness and safety of the unilateral extrapedicular approach (UEA) percutaneous vertebral augmentation and transpedicular approach percutaneous vertebral augmentation for osteoporotic vertebral compression fractures (OVCFs).

Materials and methods: Publications indexed up to May 2025 were interrogated across Cochrane Library, Web of Science, PubMed, Embase, and SpringerLink using the combined keywords “unilateral extrapedicular approach”, “transpedicular approach”, “percutaneous vertebral augmentation”, “percutaneous vertebroplasty”, “percutaneous kyphoplasty”, and “osteoporotic vertebral compression fractures”. Mean difference (MD) and risk difference (RD) served as summary metrics, each expressed with 95% confidence intervals (CIs).

Results: Eight clinical trials involving 830 patients were included. The UEA significantly shortened operative time (MD=–4.26; 95% CI:–6.15 ~ –2.37; p<0.00001), compared to unilateral transpedicular approach (UTA), while no statistically significant differences were observed in cement leakage (RD:–0.01; 95% CI:–0.09 ~ 0.07; p=0.88), cement injection volume (MD=0.20; 95% CI:–0.02 ~ 0.41; p=0.07), or intraoperative fluoroscopy times (MD=–1.15; 95% CI:–3.62 ~ 1.32; p=0.36). Notably, UEA demonstrated significant advantages over bilateral transpedicular approach (BPA) in reducing cement leakage rate (RD:–0.08; 95% CI:–0.14 ~ –0.02; p=0.01), decreasing cement injection volume (MD=–1.51; 95% CI:–2.98 ~ –0.04; p=0.04), shortening operative time (MD=–9.64; 95% CI:–13.25 ~ –6.04; p<0.00001), and minimizing intraoperative fluoroscopy times (MD=–8.12; 95% CI:–12.36 ~ –3.88; p=0.0002). However, no significant intergroup differences were found between UEA and BPA in postoperative Visual Analog Scale (VAS) (MD=–0.04; 95% CI:–0.24 ~ 0.17; p=0.73), postoperative Cobb angle (MD=–0.37; 95% CI:–0.54 ~ 1.28; p=0.42) or Oswestry Disability Index (ODI) (MD=–0.54; 95% CI:–2.81 ~ 1.72; p=0.64).

Conclusion: In the management of OVCFs, UEA offers shorter operative time compared with UTA. Additionally, UEA shows remarkable superiority over BPA in cement injection volume, cement leakage rate, intraoperative fluoroscopy frequency and operative time.

Citation: Du JF, Chen WD, Liang L. Unilateral extrapedicular versus unilateral and bilateral transpedicular approaches in percutaneous vertebral augmentation for osteoporotic vertebral compression fractures: A meta-analysis. Jt Dis Relat Surg 2026;37(1):77-87. doi: 10.52312/jdrs.2026.2464.

Contributed to conception and design of this study, study selection and data extraction of the finally included studies were done independently assessed the methodological quality of each included stud, contributed to preparation of the manuscript: J.F.D., W.D.C., L.L. The final version of the article was approved by all the authors.

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

The authors received no financial support for the research and/or authorship of this article.

The data that support the findings of this study are available from the corresponding author upon reasonable request.