Review of Vertebral Augmentation: An Updated Meta-analysis of the Effectiveness

Abstract

Background: To update vertebral augmentation literature by comparing outcomes between vertebroplasty (VP), balloon kyphoplasty (BKP), vertebral augmentation with implant (VAI), and nonsurgical management (NSM) for treating vertebral compression fractures (VCFs).Methods: A PubMed literature search was conducted with keywords kyphoplasty, vertebroplasty, vertebral body stent, and vertebral augmentation AND implant for English-language articles from February 1, 2011, to November 22, 2016. Among the results, 25 met the inclusion criteria for the meta-analysis. Inclusion criteria were prospective comparative studies for mid-/lower-thoracic and lumbar VCFs enrolling at least 20 patients. Exclusion criteria included studies that were single arm, systematic reviews and meta-analyses, traumatic nonosteoporotic or cancer-related fractures, lack of clinical outcomes, or non-Level I and non-Level II studies. Standardized mean difference between baseline and end point for each outcome was calculated, and treatment groups were pooled using random effects meta-analysis.Results: Visual analog scale pain reduction for BKP and VP was À4.05 and À3.88, respectively. VP was better than but not significantly different from NSM (À2.66), yet BKP showed significant improvement from both NSM and VAI (À2.77). The Oswestry Disability Index reduction for BKP showed a significant improvement over VAI (P , .001). There was no significant difference in changes between BKP and VP for anterior (P ¼ .226) and posterior (P ¼ .293) vertebral height restoration. There was no significant difference in subsequent fractures following BKP (32.7%; 95% confidence interval [CI]: 8.8%-56.6%) or VP (28.3%; 95% CI: 7.0%-49.7%) compared with NSM (15.9%; 95% CI: 5.2%-26.6%).Conclusions/Level of Evidence: Based on Level I and II studies, BKP had significantly better and VP tended to have better pain reduction compared with NSM. BKP tended to have better height restoration than VP. Additionally, BKP had significant improvements in pain reduction and disability score as compared with VAI.Clinical Relevance: This meta-analysis serves to further define and support the safety and efficacy of vertebral augmentation.

A Comparison of Kyphoplasty, Vertebroplasty, or Non-Surgical Treatment of Traumatic/Atraumatic Osteoporotic Vertebral Compression Fractures: A Short Review

“…[3] Here we provide a short perspective reviewing the pros and cons for these 3 treatment options for managing traumatic/atraumatic OVCFs. [1][2][3][4][5][6][7][8][9][10][11][12][13]…”

The Pain Crisis: Interventional Radiology's Role in Pain Management

“…More recently, several vertebral implants including stents, jacks, cages, and fracture reduction systems, have been used for VA [12]. However, there is no Level I evidence to suggest that these implants improved outcomes compared to traditional VA in terms of pain or disability score reduction [13].…”

ISASS Policy 2018—Vertebral Augmentation: Coverage Indications, Limitations, and/or Medical Necessity

“…Indeed, the first use of acrylic-based cement (PMMA) in the spine was performed by Galibert et al 18 in 1987 as a way to stabilize a vertebral hemangioma. Since then, more than 52 level 1 and level 2 studies were published 9,19 with the overwhelming majority in favor of the use of vertebral augmentation; some of those studies are shown in Table 2. It is now difficult to argue against the effectiveness of these minimally invasive interventions.…”

“…Balloon kyphoplasty also tended to have better vertebral body height restoration than vertebroplasty. 19 The 2013 Kyphoplasty and Vertebroplasty National Institute for Health and Care Excellence Technology Appraisal Guidance…”