Abstract
BACKGROUND: Osteoporotic vertebral compression fractures (OVCFs) are common in osteoporosis patients. Vertebral augmentation procedures like percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) are widely used, but the impact of bone cement distribution patterns on treatment efficacy remains unclear, and there is a lack of unified classification criteria. METHODS: A systematic search was conducted in multiple databases, including PubMed, Web of Science, EMBASE, and CENTRAL until September 30, 2024. Studies on OVCF patients who underwent vertebral augmentation, described cement distribution patterns, and provided clinical data were included. Data extraction and quality assessment were performed following PRISMA guidelines. RESULTS: After screening 408 papers, 21 studies with 3997 patients were included. Morphological classifications showed that a diffuse spongy distribution pattern was associated with better clinical outcomes. Directional classifications indicated that bilateral and even cement distribution led to better vertebral height restoration and pain relief. Sufficient cement distribution was crucial for treatment success, and cement contact with both upper and lower endplates reduced refracture risk. CONCLUSIONS: Cement distribution patterns significantly affect OVCF treatment efficacy. Current classifications lack standardization, necessitating objective assessment tools and large-scale studies to optimize surgical techniques and patient outcomes.