Balloon kyphoplasty or percutaneous vertebroplasty for osteoporotic vertebral compression fracture? An updated systematic review and meta-analysis

Abstract

BACKGROUNDBoth kyphoplasty (KP) and vertebroplasty (VP) are effective for patients with osteoporotic vertebral compression fracture (OVCF), but which approach might be more effective remains unclear, so we decided to update earlier systematic reviews.OBJECTIVEReview and analyze studies published as of August 2015 that compared clinical outcomes and complications of KP versus VP.DESIGNSystematic review and meta-analysis.SEARCH METHODPublished reports up to August 2015 were found in PubMed, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL).SELECTION CRITERIARandomized controlled trials (RCTs) and prospective and retrospective cohort studies comparing KP and VP in patients with OVCF.DATA COLLECTION AND ANALYSISTwo authors independently assessed the studies and extracted data.RESULTSThirty-two studies involving 3274 patients fulfilled the inclusion criteria. There were significant differences between the two groups in short- and long-term postoperative changes in measures of pain intensity and dysfunction (P<.01), in anterior and middle height (P<.01), kyphotic angle (P<.01), and time to injury, but not in posterior height (P=.178). There were no significant differences in the rate of postoperative fractures including adjacent and total fractures, but cement leakage to the intraspinal space was greater in the VP group (P=.035). KP surgery took longer and required a greater volume of injected cement.CONCLUSIONSKR resulted in better pain relief, improvements in Oswestry dysfunction and radiographic outcomes with less cement leakage, but further RCTs are needed to verify this conclusion.LIMITATIONSOnly four RCTs with a certain of risk of bias. Most studies were observational.

Effect of Kyphoplasty in the Treatment of Osteoporotic Vertebral Fractures Compared to Vertebroplasty – Overview of Systematic Reviews

“…6 The second most recent review 24 identified two randomized trials. The study conducted by Bae et al 25 27 reviewed not only primary studies, but systematic reviews as well.…”

“…The latest review was published in 2016, 6 and included 4 randomized trials, 14 prospective cohort studies, and 14 retrospective cohort studies for analysis. 6 The second most recent review 24 identified two randomized trials.…”

“…Out of these, only one (Liu et al) directly compared kyphoplasty and vertebroplasty. 28 The most complete and current review, which evaluated the largest number of publications, was conducted by Liang et al 6 All the comparative studies, including 3,274 patients (1,653 undergoing kyphoplasty and 1,621 undergoing vertebroplasty), were covered in their meta-analysis. As stated by the current evidence regarding overviews of systematic reviews, it is possible to choose the last or the best existent review to be used as the main source for a final review.…”

“…6, Visual analogue scale (after 6 months of follow-up): This outcome was assessed by 14 studies. Again, the kyphoplasty group had lower scores on the pain scale (-0.46; 95% CI -0.57 to -0.36; p < 0.01).…”

“…1 Osteoporotic fractures of the spine can lead to chronic pain, progressive deformity, reduced quality of life, and increased mortality. [1][2][3][4][5][6][7][8][9][10][11][12][13] Since 1987, bone filling techniques have become progressively widespread, with benefits in the treatment of pain and associated deformity correction. 5 Vertebroplasty was initially introduced as a spinal cementation method for treating pain and preventing or treating vertebral collapse.…”