Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2012 Sep;21(9):1844-59.
doi: 10.1007/s00586-012-2441-6. Epub 2012 Jul 26.

Balloon kyphoplasty versus percutaneous vertebroplasty in treating osteoporotic vertebral compression fracture: grading the evidence through a systematic review and meta-analysis

Xin-Long Ma  1 , Dan Xing, Jian-Xiong Ma, Wei-Guo Xu, Jie Wang, Yang Chen
Affiliations
Meta-Analysis

Balloon kyphoplasty versus percutaneous vertebroplasty in treating osteoporotic vertebral compression fracture: grading the evidence through a systematic review and meta-analysis

Xin-Long Ma et al. Eur Spine J. 2012 Sep.

Abstract

Objective: To assess the safety and efficacy of balloon kyphoplasty (KP) compared with percutaneous vertebroplasty (VP) and provide recommendations for using these procedures to treat osteoporotic vertebral compression fractures (OVCF).

Methods: A systematic search of all studies published through March 2012 was conducted using the MEDLINE, EMBASE, OVID, ScienceDirect and Cochrane CENTRAL databases. The randomized controlled trials (RCTs) and non-randomized controlled trials that compared KP to VP and provided data on safety and clinical effects were identified. Demographic characteristics, adverse events and clinical outcomes were manually extracted from all of the selected studies. The evidence quality levels and recommendations were assessed using the GRADE system.

Results: Twelve studies encompassing 1,081 patients met the inclusion criteria. Subgroup meta-analyses were performed according to the study design. In the RCT subgroup, there were significant differences between the two procedures in short-term visual analog scale (VAS), long-term kyphosis angles, operative times and anterior vertebrae heights. In the cohort study subgroup, there were significant differences between the two procedures in short- and long-term VAS, short- and long-term Oswestry Disability Index (ODI), cement leakage rates, short- and long-term kyphosis angles, operative times and anterior vertebrae heights. However, there were no significant differences in long-term VAS or adjacent vertebral fracture rates in the RCT subgroup. There were no significant differences in short- or long-term VAS, short- or long-term ODI, cement leakage rates, adjacent vertebral fracture rates, short- or long-term kyphosis angles or anterior vertebrae heights in the CCT subgroup, and the adjacent vertebral fracture rates did not differ significantly in the cohort study subgroup. The overall GRADE system evidence quality was very low, which lowers our confidence in their recommendations.

Conclusions: KP and VP are both safe and effective surgical procedures for treating OVCF. 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 fractured vertebrae. Due to the poor quality of the evidence currently available, high-quality RCTs are required.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
The study selection and inclusion process
Fig. 2
Fig. 2
The funnel plot for the cement leakage rate outcomes
Fig. 3
Fig. 3
The methodological quality of the RCTs
Fig. 4
Fig. 4
The weighted mean difference (WMD) estimates for the short-term VAS scores
Fig. 5
Fig. 5
The weighted mean difference (WMD) estimates for the long-term VAS scores
Fig. 6
Fig. 6
The weighted mean difference (WMD) estimate for the short-term ODI scores
Fig. 7
Fig. 7
The weighted mean difference (WMD) estimate for the long-term ODI scores
Fig. 8
Fig. 8
The risk ratio (RR) estimate for cement leakage
Fig. 9
Fig. 9
The risk ratio (RR) estimates for adjacent-level fractures
See this image and copyright information in PMC

References

    1. Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, Guyatt GH, Harbour RT, Haugh MC, Henry D, Hill S, Jaeschke R, Leng G, Liberati A, Magrini N, Mason J, Middleton P, Mrukowicz J, O’Connell D, Oxman AD, Phillips B, Schunemann HJ, Edejer TT, Varonen H, Vist GE, Jr, Williams JW, Zaza S. Grading quality of evidence and strength of recommendations. BMJ. 2004;328:1490. doi: 10.1136/bmj.328.7454.1490. - DOI - PMC - PubMed
    1. Atkins D, Eccles M, Flottorp S, Guyatt GH, Henry D, Hill S, Liberati A, O’Connell D, Oxman AD, Phillips B, Schunemann H, Edejer TT, Vist GE, Jr, Williams JW. Systems for grading the quality of evidence and the strength of recommendations I: critical appraisal of existing approaches The GRADE Working Group. BMC Health Serv Res. 2004;4:38. doi: 10.1186/1472-6963-4-38. - DOI - PMC - PubMed
    1. Belkoff SM, Mathis JM, Jasper LE, Deramond H. The biomechanics of vertebroplasty. The effect of cement volume on mechanical behavior. Spine (Phila Pa 1976) 2001;26:1537–1541. doi: 10.1097/00007632-200107150-00007. - DOI - PubMed
    1. Belkoff SM, Mathis JM, Jasper LE, Deramond H. An ex vivo biomechanical evaluation of a hydroxyapatite cement for use with vertebroplasty. Spine (Phila Pa 1976) 2001;26:1542–1546. doi: 10.1097/00007632-200107150-00008. - DOI - PubMed
    1. Bergland A, Thorsen H, Karesen R. Association between generic and disease-specific quality of life questionnaires and mobility and balance among women with osteoporosis and vertebral fractures. Aging Clin Exp Res. 2011;23:296–303. - PubMed

Publication types