Outcomes of revision vertebral augmentation for recurrent or adjacent osteoporotic vertebral compression fractures: a systematic review and meta-analysis

Osteoporotic vertebral compression fractures (OVCFs) are common causes of pain and disability in older adults. Although percutaneous vertebroplasty (PVP) and balloon kyphoplasty (PKP) generally provide effective relief for acute fractures, some patients develop recurrent pain due to new or adjacent-level fractures after the initial procedure. Repeat VA is increasingly used, yet its efficacy and safety have not been systematically evaluated. This study aimed to synthesize current evidence and perform a meta-analysis on clinical, radiologic, and procedural outcomes of repeat VA for recurrent or adjacent OVCFs. # Materials and Methods Following PRISMA 2020 guidelines, PubMed, Scopus, and Web of Science were searched up until October 2025 for English-language studies reporting repeat PVP or PKP for osteoporotic fractures. Continuous outcomes (VAS, ODI, SKA, cement volume) were pooled as mean differences (MDs) and complications as pooled proportions using random-effects models. Heterogeneity was assessed with the I² statistic, and publication bias with Egger's regression. # Results Fourteen retrospective cohort studies (320 patients, 358 vertebrae) were included. Repeat VA significantly improved pain and function (VAS MD = -5.58 [95% CI, -6.32 to -4.83]; ODI MD = -41.7 [95% CI, -54.9 to -28.5]) and produced modest angular correction (SKA + 5.78°, 95% CI 4.21-7.36). Complications were infrequent: cement leakage 17%, adjacent fracture 5%, and re-revision 4%. No neurological or infectious events were reported. # Conclusion Repeat vertebroplasty or BKP offers substantial pain reduction, functional recovery, and radiographic stabilization for recurrent or adjacent OVCFs, with complication rates comparable to primary augmentation.