Percutaneous cement augmentation in the treatment of osteoporotic vertebral fractures (OVFs) in the elderly: a systematic review

Abstract

Purpose A systematic review, to study treatment effects for osteoporotic vertebral fractures (OVFs) in the elderly including all available evidence from controlled trials on percutaneous cement augmentation. Methods Primary studies, published up to December, 2019, were searched in PubMed and the Cochrane Library. Selected were all prospective controlled studies including patients > 65 years of age and reporting on at least one main outcome. Main outcomes were pain, disability and quality of life (QOL) 1 day post-intervention and at 6 months postoperatively. Excluded were meta-analyses or reviews, retrospective or non-controlled studies, case studies, patients' groups with neoplastic and/ or traumatic fractures and/or neurologically compromised patients. Results Eighteen studies comprising 2165 patients (n = 1117 percutaneous cement augmentation, n = 800 conservative treatment (CT), n = 248 placebo) with a mean follow-up of up to 12 months were included. Pooled results showed significant pain relief in favor of percutaneous cement augmentation compared to CT, direct postoperative and at 6 months follow-up. At 6 months, a significant difference was observed for functional disability scores in favor of percutaneous cement augmentation. When comparing percutaneous cement augmentation to placebo, no significant differences were observed. Conclusion This review incorporates all current available evidence (RCTs and non-RCTs) on the efficacy of percutaneous cement augmentation in the treatment of OVFs in the elderly. Despite methodological heterogeneity of the included studies, this review shows overall significant sustained pain relief and superior functional effect in the short-and long term for percutaneous cement augmentation compared to conservative treatment.

Logistic regression analysis on risk factors of augmented vertebra recompression after percutaneous vertebral augmentation

“…With the progress of population aging and the numbers of old people increasing, the incidence rate of osteoporotic vertebral compression fracture (OVCF) rises year by year, which has a serious impact on the life of patients, and receives increasing attention [ 1 , 2 ]. Percutaneous vertebral augmentation (PVA) represented by percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP), which has high safety and reliable short-term efficacy, has become the most commonly used treatment for OVCF in recent years [ 3 ]. However, with the widespread application of PVA, some patients have lost the height of the injured vertebra again after surgery (without trauma), resulting in the vertebral height returning to the preoperative status, and even kyphosis deformity, which requires revision surgery when it is serious [ 4 ].…”

Percutaneous Vertebroplasty Versus Kyphoplasty for Thoracolumbar Osteoporotic Vertebral Compression Fractures in Patients with Distant Lumbosacral Pain

“…For patients with recent OVCFs whose symptoms and signs are consistent with imaging results, vertebral augmentation is a safe and effective treatment and is significantly better than conservative treatment in reducing long-term mortality (2,4). In addition, the ef-fectiveness of PVP (16) or PKP (5) is not affected when there is no local tenderness of the fractured vertebral body before surgery.…”

“…Typical signs include restricted mobility, kyphosis, and local tenderness in the diseased vertebra. For patients with recent OVCF and whose symptoms and signs are consistent with imaging results, vertebral augmentation is a safe and effective treatment and can quickly relieve pain, correct kyphosis, improve quality of life, and reduce long-term mortality (2)(3)(4). However, it has been observed in clinical practice that the pain caused by thoracolumbar OVCF is sometimes not limited to the level of the fractured vertebrae but instead occurs in areas far away from the injured vertebrae, such as the lower back, area surrounding the iliac crest (ASIC), or buttocks.…”

Logistic regression analysis on risk factors of augmented vertebra recompression after percutaneous vertebral augmentation

“…With the progress of population aging and the numbers of old people increasing the incidence rate of osteoporotic vertebral compression fracture OVCF rises year by year which has a serious impact on the life of patients, and receives increasing attention [1,2]. Percutaneous vertebral augmentation (PVA) represented by percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP), which has high safety and reliable short-term e cacy, has become the most commonly used treatment for OVCF in recent years [3]. However, with the widespread application of PVA some patients have lost the height of the injured vertebra again after surgery (without trauma) resulting in the vertebral height returning to the preoperative status, and even kyphosis deformity, which requires revision surgery when it is serious [4].…”