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

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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 ≥20 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 (4.8º 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.

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Abbreviations

VCF(s):

Vertebral compression fracture(s)

BKP:

Balloon kyphoplasty

VP:

Vertebroplasty

VAPs:

Vertebral augmentation procedures

NSM:

Non-surgical management

RCT(s):

Randomized controlled trial(s)

PRISMA:

Preferred reporting items for systematic reviews and meta-analyses

ITC:

Indirect treatment comparisons

RMD:

Rolland morris disability

ODI:

Oswestry disability index

QOL:

Quality of life

PCS:

Physical component summary

VAS:

Visual analog scale

SAE(s):

Serious adverse event(s)

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Acknowledgments

We thank Mohammed Eleraky, MD (Moffitt Cancer Center, Tampa, FL) for validation and verification of the extracted data.

Conflict of interest

Frank M. Phillips, Jan Van Meirhaeghe, James R. Berenson and Frank D. Vrionis are consultants for Medtronic and have received grants and honoraria. Brent J. Small and Gary Chung were paid from Medtronic to conduct an independent statistical analysis.

Author information

Authors and Affiliations

  1. H. Lee Moffitt Cancer Center and Research Institute, NeuroOncology Program and Department of Neurosurgery and Orthopaedics, University of South Florida College of Medicine, 12902 Magnolia Drive, Tampa, FL, 33647, USA

    Ioannis D. Papanastassiou, Kamran Aghayev & Frank D. Vrionis

  2. Department of Orthopedics, General Oncological Hospital “Agioi Anargyroi”, Athens, Greece

    Ioannis D. Papanastassiou

  3. Dienst Orthopedie en Traumatologie, Algemeen Ziekenhuis Sint-Jan Brugge-Oostende AV, Brugge, Belgium

    Jan Van Meirhaeghe

  4. Medtronic Spinal and Biologics, Kyphon Products Division, Sunnyvale, CA, USA

    Gary Chung

  5. School of Aging Studies, University of South Florida, Tampa, FL, USA

    Brent J. Small

  6. Department of Orthopedics, Rush University Medical Center, Chicago, IL, USA

    Frank M. Phillips & Gunnar B. J. Andersson

  7. Institute for Myeloma and Bone Cancer Research, West Hollywood, CA, USA

    James R. Berenson

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Correspondence to Ioannis D. Papanastassiou.

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Papanastassiou, I.D., Phillips, F.M., Van Meirhaeghe, J. et al. Comparing effects of kyphoplasty, vertebroplasty, and non-surgical management in a systematic review of randomized and non-randomized controlled studies. Eur Spine J 21, 1826–1843 (2012). https://doi.org/10.1007/s00586-012-2314-z

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  • DOI: https://doi.org/10.1007/s00586-012-2314-z

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