Restoration of Sagittal Alignment and Pulmonary Function With Percutaneous Vertebral Body Augmentation for Painful Osteoporotic Vertebral Compression Fractures: A Systematic Review.

Sagittal spinal malalignment is associated with functional disability. Therefore, a key question in treating patients with painful osteoporotic vertebral compression fractures (OVCFs) is whether vertebral augmentation improves sagittal alignment and its associated outcomes. In a systematic literature review based on interventional and observational studies, we evaluated the effect of percutaneous vertebral body augmentation on sagittal alignment and pulmonary function in patients with painful OVCFs. In November 2022 and December 2023, we searched for relevant studies in Medline, Embase, SCOPUS, Web of Science, the Cochrane Central Registry of Controlled Trials, and five trial registries. In total, 15 cohort studies and two non-randomized clinical trials met our inclusion criteria. Participants in these studies had painful OVCFs treated with vertebral body augmentation. Sagittal alignment outcomes from nine articles represented 456 participants with mean ages from 69.3 to 80.8 years, and pulmonary function outcomes from eight articles represented 343 participants with mean ages from 69.1 to 75.7 years. The quality assessment tool for quantitative studies by the Effective Public Health Practice Project assessed the risk of bias (RoB). Mean pre- and postoperative outcome values were calculated for all included studies and those without a high RoB. None of the sagittal alignment parameters improved after vertebral augmentation, and no additional deformity was detected. Vertebral augmentation positively affected pulmonary function, as measured by the percentage of predicted values, and reduced perceived pain levels and functional disability. Data in the included studies were incomplete due to variability in chosen outcomes and follow-up time points. The incomplete data curtailed our data analysis and only allowed cautious conclusions. Variations in study populations and protocols highlight the need for standardized reporting and follow-up in future research.