Comparing effects of kyphoplasty, vertebroplasty, and non-surgical management in a systematic review of randomized and non-randomized controlled studies

Abstract

Purpose To determine if differences in safety or efficacy exist between balloon kyphoplasty (BKP), vertebroplasty (VP) and non-surgical management (NSM) for the treatment of osteoporotic vertebral compression fractures (VCFs). Methods As of February 1, 2011, a PubMed search (key words: kyphoplasty, vertebroplasty) resulted in 1,587 articles out of which 27 met basic selection criteria (prospective multiple-arm studies with cohorts of C20 patients).This systematic review adheres to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines.Results Pain reduction in both BKP (-5.07/10 points, P \ 0.01) and VP (-4.55/10, P \ 0.01) was superior to that for NSM (-2.17/10), while no difference was found between BKP/VP (P = 0.35). Subsequent fractures occurred more frequently in the NSM group (22 %) compared with VP (11 %, P = 0.04) and BKP (11 %, P = 0.01). BKP resulted in greater kyphosis reduction than VP (4.88 vs. 1.7°, P \ 0.01). Quality of life (QOL) improvement showed superiority of BKP over VP (P = 0.04), along with a trend for disability improvement (P = 0.08). Cement extravasation was less frequent in the BKP (P = 0.01). Surgical intervention within the first 7 weeks yielded greater pain reduction than VCFs treated later. Conclusions BKP/VP provided greater pain relief and fewer subsequent fractures than NSM in osteoporotic VCFs. BKP is marginally favored over VP in disability improvement, and significantly favored in QOL improvement. BKP had a lower risk of cement extravasation and resulted in greater kyphosis correction. Despite this analysis being restricted to Level I and II studies, significant heterogeneity suggests that the current literature is delivering inconsistent messages and further trials are needed to delineate confounding variables.

A Randomized Trial Comparing Balloon Kyphoplasty and Vertebroplasty for Vertebral Compression Fractures due to Osteoporosis

“…25 Similarly, improvements of Ն4 points exceeded the 1-to 2.5-point threshold for back pain, 19,25 improvements of Ͼ25 points exceeded the 10-to 15-point threshold for ODI, 20,25 and improvements of Ն0.28 points exceeded the 0.08 threshold for EQ-5D. 26 Cumulative evidence demonstrates that kyphoplasty and vertebroplasty provide better outcome than nonsurgical management in RCTs and meta-analyses 4,5,7,[9][10][11]27,28 and acceptable cost-effectiveness ratios. 11,[29][30][31] Several large retrospective studies using claims data, investigating BKP, VP, and nonsurgical management, provide additional evidence.…”

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.…”

Minimally invasive procedures for the management of vertebral bone pain due to cancer: The EAPC recommendations

“…While there are several trials assessing the efficacy of vertebral percutaneous procedures suggesting that these procedures may have a role, the number of the series and quality of data remain quite low, and most of these studies did not provide evident proofs of efficacy in cancer patients with vertebral bone tumors or vertebral metastases. Potential flaws confounding the outcomes include low accrual rate, inclusion of patients with different types of fractures, not-uniform evaluation of fractures, and other pain generators unrelated to the fracture, very problematic eventual sham design, no reported clinical examination to determine the source of pain [19].…”