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Background <p>Current evidence on the effect of the transverse process-pedicle approach (TPPA) in percutaneous kyphoplasty (PKP) remains limited. This study compares the safety and efficacy of TPPA versus conventional transpedicular approach (CTPA) in PKP for osteoporotic vertebral compression fractures (OVCFs).</p> Methods <p>A systematic search was performed in PubMed, Web of Science, Embase, the Cochrane Library, and Scopus to identify prospective or retrospective studies comparing TPPA and CTPA in PKP. Studies published up to October 2025 were included. The meta-analysis was conducted using R version 4.5.1 with the meta package.</p> Results <p>Seven studies, including 1,014 OVCF patients, were analyzed. Compared with CTPA-PKP, TPPA-PKP results in lower radiation exposure (SMD = -1.53, 95% CI: -2.69 to -0.37), a reduced cement leakage rate (OR = 0.54, 95% CI: 0.37 to 0.77), and lower Oswestry Disability Index score (MD = -2.16, 95% CI: -3.64 to -0.69). TPPA-PKP may improve vertebral height restoration (MD = 0.45, 95% CI: 0.12 to 0.79) compared with CTPA-PKP, but the evidence is inconsistent. Moreover, TPPA-PKP and CTPA-PKP showed similar improvements in Visual Analog Scale score (MD = -0.18, 95% CI: -0.41 to 0.05) and Cobb angle (MD = -0.49, 95% CI: -1.05 to 0.07).</p> Conclusion <p>TPPA-PKP suggests potential advantages in safety and functional recovery compared with CTPA-PKP for OVCFs; however, the low-certainty evidence according to the GRADE warrants caution in interpretation. CTPA-PKP remains widely used in clinical practice. Further standardization of TPPA-PKP procedures may facilitate its broader adoption.</p>

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Transverse process-pedicle versus conventional transpedicular approach in percutaneous kyphoplasty for osteoporotic vertebral compression fractures: a systematic review and pilot meta-analysis

  • 期刊论文

  • 发表日期：

    2026年5月21日

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  • Yihao Tao,
  • Mufei Wang,
  • Hekai Shi,
  • Chao Yin,
  • Qiuzhe Wei,
  • Bo Wang

摘要

Background

Current evidence on the effect of the transverse process-pedicle approach (TPPA) in percutaneous kyphoplasty (PKP) remains limited. This study compares the safety and efficacy of TPPA versus conventional transpedicular approach (CTPA) in PKP for osteoporotic vertebral compression fractures (OVCFs).

Methods

A systematic search was performed in PubMed, Web of Science, Embase, the Cochrane Library, and Scopus to identify prospective or retrospective studies comparing TPPA and CTPA in PKP. Studies published up to October 2025 were included. The meta-analysis was conducted using R version 4.5.1 with the meta package.

Results

Seven studies, including 1,014 OVCF patients, were analyzed. Compared with CTPA-PKP, TPPA-PKP results in lower radiation exposure (SMD = -1.53, 95% CI: -2.69 to -0.37), a reduced cement leakage rate (OR = 0.54, 95% CI: 0.37 to 0.77), and lower Oswestry Disability Index score (MD = -2.16, 95% CI: -3.64 to -0.69). TPPA-PKP may improve vertebral height restoration (MD = 0.45, 95% CI: 0.12 to 0.79) compared with CTPA-PKP, but the evidence is inconsistent. Moreover, TPPA-PKP and CTPA-PKP showed similar improvements in Visual Analog Scale score (MD = -0.18, 95% CI: -0.41 to 0.05) and Cobb angle (MD = -0.49, 95% CI: -1.05 to 0.07).

Conclusion

TPPA-PKP suggests potential advantages in safety and functional recovery compared with CTPA-PKP for OVCFs; however, the low-certainty evidence according to the GRADE warrants caution in interpretation. CTPA-PKP remains widely used in clinical practice. Further standardization of TPPA-PKP procedures may facilitate its broader adoption.