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Meta-Analysis
. 2019 Nov;98(45):e17810.
doi: 10.1097/MD.0000000000017810.

Therapeutic effect of kyphoplasty and balloon vertebroplasty on osteoporotic vertebral compression fracture: A systematic review and meta-analysis of randomized controlled trials

Yi Zhu  1   2 , Jie Cheng  3 , Jichao Yin  4 , Zhijie Zhang  5 , Chunlong Liu  6 , Dingjun Hao  1
Affiliations
Meta-Analysis

Therapeutic effect of kyphoplasty and balloon vertebroplasty on osteoporotic vertebral compression fracture: A systematic review and meta-analysis of randomized controlled trials

Yi Zhu et al. Medicine (Baltimore). 2019 Nov.

Abstract

Introduction: This study aimed to assess the treatment effects of kyphoplasty (KP) compared with percutaneous vertebroplasty (VP) in patients with osteoporotic vertebral compression fracture, based on evidence from randomized controlled trials (RCTs).

Methods: The electronic databases PubMed (from 1966), EmBase (from 1974), and Cochrane Library (including Cochrane Central Register of Controlled Trials and Cochrane Reviews) were searched systematically to identify relevant studies published up to August 31, 2019. Meta-analyses were conducted for subjective pain as measured using visual analogue scale (VAS), disability function as measured by Oswestry disability index (ODI), and cement leakage. For VAS and ODI, mean change from the baseline and standard deviation were used; for cement leakage, numbers of events and patients in each group were used. The random-effects model was applied to summarize the effects across trials.

Results: Previous reviews and meta-analysis included non-RCTs, which brought (for those studies) a higher risk of bias. Therefore, 6 RCTs involving 1077 patients were included in the meta-analysis. No between-group difference was found. The weighted mean difference was -0.19 (95% confidence interval [CI], -0.39-0.01; P = .057) for VAS and -3.51 (95% CI, -8.70-1.67; P = .184) for ODI. However, KP had numerically lower rates of cement leakage across trials in a consistent fashion (relative risk, 0.83; 95% CI, 0.74-0.94; P = .004).

Conclusions: Both KP and VP had clinically meaningful beneficial effects on pain and disability, and the effects were stable and similar. KP had significantly fewer cement leakages.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Flowchart of study selection and inclusion process.
Figure 2
Figure 2
(A and B) Cochrane risk-of-bias evaluations.
Figure 3
Figure 3
Forest plot showing the WMD estimates for VAS. KP = kyphoplasty, VAS = visual analogue scale, VP = vertebroplasty, WMD = weighted mean difference.
Figure 4
Figure 4
Forest plot showing the WMD estimates for ODI. KP = kyphoplasty, ODI = Oswestry disability index, VP = vertebroplasty, WMD = weighted mean difference.
Figure 5
Figure 5
Forest plot showing the risk ratio estimates for cement leakage. CI = confidence interval, KP = kyphoplasty, RR = relative risk, VP = vertebroplasty.
Figure 6
Figure 6
Sensitivity analysis of the standardized mean difference estimates for pain. CI = confidence interval, KP = kyphoplasty, VP = vertebroplasty.
Figure 7
Figure 7
Funnel plot for publication bias test of VAS outcome. VAS = visual analogue scale, WMD = weighted mean difference.
Figure 8
Figure 8
Funnel plot for publication bias test of ODI outcome. ODI = Oswestry disability index, WMD = weighted mean difference
Figure 9
Figure 9
Funnel plot for publication bias test of cement leakage outcome. RR = relative risk.
See this image and copyright information in PMC

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