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

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