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Comparative Study
. 2012 Sep;21(9):1826-43.
doi: 10.1007/s00586-012-2314-z. Epub 2012 Apr 29.

Comparing effects of kyphoplasty, vertebroplasty, and non-surgical management in a systematic review of randomized and non-randomized controlled studies

Ioannis D Papanastassiou  1 , Frank M Phillips, Jan Van Meirhaeghe, James R Berenson, Gunnar B J Andersson, Gary Chung, Brent J Small, Kamran Aghayev, Frank D Vrionis
Affiliations
Comparative Study

Comparing effects of kyphoplasty, vertebroplasty, and non-surgical management in a systematic review of randomized and non-randomized controlled studies

Ioannis D Papanastassiou et al. Eur Spine J. 2012 Sep.

Abstract

Purpose: To determine if differences in safety or efficacy exist between balloon kyphoplasty (BKP), vertebroplasty (VP) and non-surgical management (NSM) for the treatment of osteoporotic vertebral compression fractures (VCFs).

Methods: As of February 1, 2011, a PubMed search (key words: kyphoplasty, vertebroplasty) resulted in 1,587 articles out of which 27 met basic selection criteria (prospective multiple-arm studies with cohorts of ≥ 20 patients). This systematic review adheres to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines.

Results: Pain reduction in both BKP (-5.07/10 points, P < 0.01) and VP (-4.55/10, P < 0.01) was superior to that for NSM (-2.17/10), while no difference was found between BKP/VP (P = 0.35). Subsequent fractures occurred more frequently in the NSM group (22 %) compared with VP (11 %, P = 0.04) and BKP (11 %, P = 0.01). BKP resulted in greater kyphosis reduction than VP (4.8º vs. 1.7°, P < 0.01). Quality of life (QOL) improvement showed superiority of BKP over VP (P = 0.04), along with a trend for disability improvement (P = 0.08). Cement extravasation was less frequent in the BKP (P = 0.01). Surgical intervention within the first 7 weeks yielded greater pain reduction than VCFs treated later.

Conclusions: BKP/VP provided greater pain relief and fewer subsequent fractures than NSM in osteoporotic VCFs. BKP is marginally favored over VP in disability improvement, and significantly favored in QOL improvement. BKP had a lower risk of cement extravasation and resulted in greater kyphosis correction. Despite this analysis being restricted to Level I and II studies, significant heterogeneity suggests that the current literature is delivering inconsistent messages and further trials are needed to delineate confounding variables.

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Figures

Fig. 1
Fig. 1
Literature search and selection
Fig. 2
Fig. 2
Change in disability from baseline and forest plot
Fig. 3
Fig. 3
Change in quality of life from baseline and forest plot
Fig. 4
Fig. 4
Change in pain from baseline and forest plot
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Fig. 5
Subsequent fracture rate and forest plot
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Fig. 6
Cement extravasation rate and forest plot
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Fig. 7
Kyphotic angle and forest plot
Fig. 8
Fig. 8
Meta-regression of fracture age versus pain reduction in vertebroplasty and kyphoplasty
See this image and copyright information in PMC

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