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Meta-Analysis
. 2012 Oct;470(10):2785-99.
doi: 10.1007/s11999-012-2404-6. Epub 2012 Jun 23.

Is there really no benefit of vertebroplasty for osteoporotic vertebral fractures? A meta-analysis

Ming-Min Shi  1 , Xun-Zi Cai, Tiao Lin, Wei Wang, Shi-Gui Yan
Affiliations
Meta-Analysis

Is there really no benefit of vertebroplasty for osteoporotic vertebral fractures? A meta-analysis

Ming-Min Shi et al. Clin Orthop Relat Res. 2012 Oct.

Abstract

Background: Osteoporotic vertebral compressed fractures (VCFs) are the most common osteoporotic fractures. Although percutaneous vertebroplasty (PVP) reportedly relieves pain and improves function, a recent pooled analysis from two multicenter randomized controlled trials concluded the improvement in pain and disability treated with PVP was similar to those with sham surgery.

Questions/purpose: Using meta-analysis we therefore asked whether compared with either nonoperative therapy or a sham injection for patients with VCF, PVP would (1) better relieve pain, (2) provide greater improvement in pain-related disability, and (3) increase the recurrence of vertebral fractures.

Methods: We searched PubMed, EMBASE, Medline, and the Cochrane library using the keywords "vertebroplasty AND osteoporosis OR fracture". We included nine of the 469 articles identified. Using a random effects model, we calculated the weighted mean differences to evaluate the pain reduction at different times as the primary outcome. Pain-related disability was assessed by a quality of life (QOL) measure. Improvement of QOL and recurrence of vertebral fractures were the secondary outcomes. We used subgroup analysis to reinvestigate pain relief and function improvement of PVP based on two different controls: nonoperative therapy and sham injection. The total number of patients was 886.

Results: Pain scoring was similar between the PVP group and the sham injection group at 1 to 29 days and 90 days. However, compared with nonoperative therapy, PVP reduced pain at all times studied. QOL in the PVP group was improved or tended to be improved compared with QOL for both control groups. The risk of new fractures was similar between the PVP groups and both control groups.

Conclusions: Different control groups may have accounted for the different conclusions in the literature regarding the ability of PVP to relieve pain and restore function recovery. Compared with nonoperative treatment PVP relieved pain better and improved QOL. PVP did not increase the risk of new fractures.

Level of evidence: Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Figures

Fig. 1
Fig. 1
A flowchart illustrates the selection of nine trials included in our meta-analysis.
Fig. 2
Fig. 2
The forest plot for pain relief at 1 to 29 days shows a difference between vertebroplasty and nonoperative therapy but no difference between vertebroplasty and sham injection. IV = inverse variance; PVP = percutaneous vertebroplasty.
Fig. 3
Fig. 3
The forest plot for pain relief at 90 days shows a difference between vertebroplasty and nonoperative therapy but no difference between vertebroplasty and sham injection. IV = inverse variance; PVP = percutaneous vertebroplasty.
Fig. 4
Fig. 4
The forest plot for pain relief greater than 180 days shows a difference between vertebroplasty and nonoperative therapy but no difference between vertebroplasty and sham injection. IV = inverse variance; PVP = percutaneous vertebroplasty.
Fig. 5
Fig. 5
The forest plot shows pain relief in the subgroup for which pain of recent onset was 6 weeks or less compared with control treatment at 1 to 29 days. IV = inverse variance; PVP = percutaneous vertebroplasty.
Fig. 6
Fig. 6
The forest plot shows pain relief in the subgroup for which pain of recent onset was 6 weeks or less compared with control treatment at 30 to 90 days. IV = inverse variance; PVP = percutaneous vertebroplasty.
Fig. 7A–D
Fig. 7A–D
Asymmetry for the outcomes at different times shows moderate publication bias in pain score at (A) 1 to 29 days, (B) 90 days, (C) 180 days, and (D) reoccurrence of fracture. MD = mean difference; RR = risk ratio.
Fig. 8
Fig. 8
The forest plot shows improvement of QOL in the PVP group assessed by the RDQ score at 30 days. QOL = quality of life; PVP = percutaneous vertebroplasty; RDQ = Roland-Morris Disability Questionnaire; IV = inverse variance.
Fig. 9
Fig. 9
The forest plot shows improvement of QOL in the PVP group assessed by the RDQ score at 90 days. QOL = quality of life; PVP = percutaneous vertebroplasty; RDQ = Roland-Morris Disability Questionnaire; IV = inverse variance.
Fig. 10
Fig. 10
The forest plot shows improvement of QOL in the PVP group assessed by the EQ-5D score. EQ-5D = European Quality of Life-5 Dimensions; PVP = percutaneous vertebroplasty; IV = inverse variance.
Fig. 11
Fig. 11
The forest plot shows improvement of QOL in the PVP group assessed by QUALEFFO score. QOL = quality of life; PVP = percutaneous vertebroplasty; IV = inverse variance.
Fig. 12
Fig. 12
The forest plot for risk of new fractures shows no difference in the risk of new fractures was seen between PVP and controlled treatment. PVP = percutaneous vertebroplasty; M-H = Mantel-Haenszel.
See this image and copyright information in PMC

Comment in

References

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