Balloon kyphoplasty versus percutaneous vertebroplasty for treatment of osteoporotic vertebral compression fractures (OVCFs)

Abstract

The study investigated whether kyphoplasty (KP) was superior to vertebroplasty (VP) in treating patients with osteoporotic vertebral compression fractures (OVCFs). KP may be superior to VP for treating patients with OVCFs based on long-term VAS and ODI but not short-term VAS. Further large-scale trials are needed to verify these findings due to potential risk of selection bias.

Introduction: This study aimed to assess whether KP was superior to VP in treating patients with OVCFs.

Methods: The Medline, Embase, and Cochrane databases and references within articles and proceedings of major meetings were systematically searched. Eligible studies included patients with OVCFs who received either KP or VP. Standard mean differences (SMDs) and relative risks (RRs) were used as measures of efficacy and safety in a random-effects model.

Results: Eleven studies enrolling 869 patients with OVCFs were identified as eligible for final analysis. Compared with VP, KP was associated with significant improvements in long-term (SMD, -0.70; 95 % confidence interval [CI]: -1.30, -0.10; P = 0.023) visual analog scale (VAS); short-term (SMD, -1.50; 95 % CI: -2.94, -0.07; P = 0.040) and long-term (SMD, -1.03; 95 % CI: -1.88, -0.18; P = 0.017) Oswestry Disability Indexes (ODIs); short-term (SMD, -0.74; 95 % CI: -1.42, -0.06; P = 0.032) and long-term (SMD, -0.71; 95 % CI: -1.19, -0.23; P = 0.004) kyphosis angles; and vertebral body height (SMD, 1.56; 95 % CI: 0.62, 2.49; P = 0.001) and anterior vertebral body height (SMD, 3.04; 95 % CI: 0.53, 5.56; P = 0.018). KP was also associated with a significantly longer operation time (SMD, 0.73; 95 % CI: 0.26, 1.19; P = 0.002) and a lower risk of cement extravasation (RR, 0.68; 95 % CI: 0.48, 0.96; P = 0.030) compared with VP. No significant differences were found in the short-term VAS, posterior vertebral body height, and adjacent-level fractures.

Conclusion: Acknowledging some risk of selection bias, KP displayed a significantly better performance compared with VP only in one of the two primary endpoints, that is, for ODI but not for short-term VAS. Further randomized studies are required to confirm these results.

Keywords: Kyphoplasty; Meta-analysis; Osteoporotic vertebral compression fractures; Vertebroplasty.