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OBJECTIVE: To assess the safety and efficacy of balloon kyphoplasty (KP) compared withpercutaneous vertebroplasty (VP) and provide recommendations for using these procedures to treatosteoporotic vertebral compression fractures (OVCF).METHODS: A systematic search of all studies published through March 2012 wasconducted using the MEDLINE,EMBASE,OVID,ScienceDirect and Cochrane CENTRALdatabases.The randomized controlled trials (RCTs) and non-randomized controlled trials thatcompared KP to VP and provided data on safety and clinical effects were identified.Demographiccharacteristics,adverse events and clinical outcomes were manually extracted from all of theselected studies.The evidence quality levels and recommendations were assessed using theGRADE system.RESULTS: Twelve studies encompassing 1081 patients met the inclusion criteria.Subgroupmeta-analyses were performed according to the study design.In the RCT subgroup,there weresignificant differences between the two procedures in short-term visual analogue scale (VAS),long-term kyphosis angles,operative times and anterior vertebrae heights.In the cohort studysubgroup,there were significant differences between the two procedures in short- and long-termVAS,short- and long-term Oswestry Disability Index (ODI),cement leakage rates,shortandlong-term kyphosis angles,operative times and anterior vertebrae heights.However,therewere no significant differences in long-term VAS or adjacent vertebral fractures rates in the RCTsubgroup.There were no significant differences in short- or long-term VAS,short- or long-termODI,cement leakage rates,adjacent vertebral fractures rates,short- or long-term kyphosisangles or anterior vertebrae heights in the CCT subgroup,and the adjacent vertebral fracturesrates did not differ significantly in the cohort study subgroup.The overall GRADE system evidencequality was very low,which lowers our confidence in their recommendations.CONCLUSIONS: KP and VP are both safe and effective surgical procedures for treatingOVCF.KP may be superior to VP in patients with large kyphosis angles,vertebral fissures,fractures in the posterior edge of the vertebral body,or significant height loss in the fracturedvertebrae.Due to the poor quality of the evidence currently available,high-quality RCTs arerequired.