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

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 longterm 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, highquality RCTs are required.

Meta-analysis of vertebral augmentation compared with conservative treatment for osteoporotic spinal fractures

“…Two recent meta-analyses show minimal long-term differences between the two cement techniques, although in one analysis the more severe fractures did better with kyphoplasty at early time points, whereas the other showed better short-term relief with vertebroplasty. (18,19) Other differences, such as unilateral versus bilateral injections and injection volume, were not standardized and could have an influence on outcomes and adverse events, but sensitivity results suggest that the true effect was insensitive to individual study variables. Finally, the training and experience of those providing both operative and nonoperative care may affect outcomes but could not be assessed.…”

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

“…Among these, the following reviews were analyzed: three reviews comparing kyphoplasty versus vertebroplasty versus conservative treatment; 15-17 three reviews comparing kyphoplasty versus conservative treatment; [18][19][20] and six reviews comparing kyphoplasty and vertebroplasty. [17][18][19][21][22][23] Head-to-head comparisons of vertebroplasty versus kyphoplasty were the object of this analysis. Because there was an overlapping of the reviews above mentioned, the final number of studies evaluated was 9 (►Fig.…”

“…Its major drawback is that it involves the direct injection of cement at high temperatures into the Haversian canals within the trabecular bone, 5 with risk of leakage into the spinal structures, potential damage to the spinal cord, and paraplegia. 5,[13][14][15][16][17][18][19][20] Kyphoplasty was developed to address the limitations and risks of vertebroplasty. The procedure was first performed in 1998, and its goals are similar to those of vertebroplasty.…”

Controversies on Vertebroplasty and Kyphoplasty for Vertebral Compression Fractures

“…19 Ma et al, 20 in a recent meta-analysis of randomized and non-randomized clinical trials, concluded that both procedures are safe and effective. The also suggest that kyphoplasty could be superior to vertebroplasty 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.…”