Skip to main content
SpringerLink
Log in

Percutaneous vertebroplasty versus balloon kyphoplasty for treatment of osteoporotic vertebral compression fracture: a meta-analysis of randomised and non-randomised controlled trials

  • Review
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

There is still debate over whether vertebroplasty (VP) or kyphoplasty (KP) is superior for the treatment of osteoporosis vertebral compression fractures (VCFs). We performed a systematic review and meta-analysis of randomised and non-randomised controlled trials comparing VP with KP to reach a relatively conclusive answer.

Methods

We searched computerised databases comparing efficacy and safety of VP and KP in osteoporotic fractures. These trials reported pain relief (Visual Analogue Scale), disability (Oswestry disability score) and complications (i.e., cement leakage, incident fractures) as the primary outcome.

Results

Eight studies involving 848 patients were identified. The outcome showed that VP is more effective in the short-term (no more than seven days) pain relief. Kyphoplasty had a superior capability for intermediate-term (around three months) functional improvement. As for long-term pain relief and functional improvement, there is no significant difference between these two interventions. Consistently, both interventions have similar risk for subsequent fracture and cement leakage.

Conclusion

Thus considering the higher cost of the KP procedure, we recommend VP over KP for the treatment of osteoporotic VCFs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

Abbreviations

VCFs:

Vertebral compression fractures

VP:

Vertebroplasty

KP:

Kyphoplasty

RCTs:

Randomised controlled trials

NRTs:

Non-randomised controlled trials

CCTs:

Clinical controlled trials

VAS:

Visual analog scale

ODI:

Oswestry disability score

RR:

Relative risks

WMD:

Weighted mean difference

References

  1. Dennison E, Cooper C (2000) Epidemiology of osteoporotic fractures. Horm Res 54(Suppl 1):58–63

    PubMed  CAS  Google Scholar 

  2. Harris ST, Watts NB, Genant HK, McKeever CD, Hangartner T, Keller M, Chesnut CH 3rd, Brown J, Eriksen EF, Hoseyni MS, Axelrod DW, Miller PD (1999) Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy With Risedronate Therapy (VERT) Study Group. JAMA 282(14):1344–1352

    Article  PubMed  CAS  Google Scholar 

  3. Dickman CA, Fessler RG, MacMillan M, Haid RW (1992) Transpedicular screw-rod fixation of the lumbar spine: operative technique and outcome in 104 cases. J Neurosurg 77(6):860–870. doi:10.3171/jns.1992.77.6.0860

    Article  PubMed  CAS  Google Scholar 

  4. Phillips FM (2003) Minimally invasive treatments of osteoporotic vertebral compression fractures. Spine (Phila Pa 1976) 28(15 Suppl):S45–53. doi:10.1097/01.BRS.0000076898.37566.32

    Google Scholar 

  5. Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17(12):1726–1733. doi:10.1007/s00198-006-0172-4

    Article  PubMed  CAS  Google Scholar 

  6. Klazen CA, Lohle PN, de Vries J, Jansen FH, Tielbeek AV, Blonk MC, Venmans A, van Rooij WJ, Schoemaker MC, Juttmann JR, Lo TH, Verhaar HJ, van der Graaf Y, van Everdingen KJ, Muller AF, Elgersma OE, Halkema DR, Fransen H, Janssens X, Buskens E, Mali WP (2010) Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial. Lancet 376(9746):1085–1092. doi:10.1016/S0140-6736(10)60954-3

    Article  PubMed  Google Scholar 

  7. Wardlaw D, Cummings SR, Van Meirhaeghe J, Bastian L, Tillman JB, Ranstam J, Eastell R, Shabe P, Talmadge K, Boonen S (2009) Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (FREE): a randomised controlled trial. Lancet 373(9668):1016–1024. doi:10.1016/S0140-6736(09)60010-6

    Article  PubMed  Google Scholar 

  8. Taylor RS, Fritzell P, Taylor RJ (2007) Balloon kyphoplasty in the management of vertebral compression fractures: an updated systematic review and meta-analysis. Eur Spine J 16(8):1085–1100. doi:10.1007/s00586-007-0308-z

    Article  PubMed  Google Scholar 

  9. Ploeg WT, Veldhuizen AG, The B, Sietsma MS (2006) Percutaneous vertebroplasty as a treatment for osteoporotic vertebral compression fractures: a systematic review. Eur Spine J 15(12):1749–1758. doi:10.1007/s00586-006-0159-z

    Article  PubMed  Google Scholar 

  10. Lee MJ, Dumonski M, Cahill P, Stanley T, Park D, Singh K (2009) Percutaneous treatment of vertebral compression fractures: a meta-analysis of complications. Spine Phila Pa 1976 34(11):1228–1232. doi:10.1097/BRS.0b013e3181a3c742

    Article  PubMed  Google Scholar 

  11. Karlsson MK, Hasserius R, Gerdhem P, Obrant KJ, Ohlin A (2005) Vertebroplasty and kyphoplasty: New treatment strategies for fractures in the osteoporotic spine. Acta Orthop 76(5):620–627. doi:10.1080/17453670510041682

    Article  PubMed  Google Scholar 

  12. Hulme PA, Krebs J, Ferguson SJ, Berlemann U (2006) Vertebroplasty and kyphoplasty: a systematic review of 69 clinical studies. Spine Phila Pa 1976 31(17):1983–2001. doi:10.1097/01.brs.0000229254.89952.6b

    Article  PubMed  Google Scholar 

  13. Eck JC, Nachtigall D, Humphreys SC, Hodges SD (2008) Comparison of vertebroplasty and balloon kyphoplasty for treatment of vertebral compression fractures: a meta-analysis of the literature. Spine J 8(3):488–497. doi:10.1016/j.spinee.2007.04.004

    Article  PubMed  Google Scholar 

  14. Gill JB, Kuper M, Chin PC, Zhang Y, Schutt R Jr (2007) Comparing pain reduction following kyphoplasty and vertebroplasty for osteoporotic vertebral compression fractures. Pain Physician 10(4):583–590

    PubMed  Google Scholar 

  15. Taylor RS, Taylor RJ, Fritzell P (2006) Balloon kyphoplasty and vertebroplasty for vertebral compression fractures: a comparative systematic review of efficacy and safety. Spine Phila Pa 1976 31(23):2747–2755. doi:10.1097/01.brs.0000244639.71656.7d

    Article  PubMed  Google Scholar 

  16. Furlan AD, Pennick V, Bombardier C, van Tulder M (2009) 2009 updated method guidelines for systematic reviews in the Cochrane Back Review Group. Spine Phila Pa 1976 34(18):1929–1941. doi:10.1097/BRS.0b013e3181b1c99f

    Article  PubMed  Google Scholar 

  17. Bhandari M, Bajammal S, Guyatt GH, Griffith L, Busse JW, Schunemann H, Einhorn TA (2005) Effect of bisphosphonates on periprosthetic bone mineral density after total joint arthroplasty. A meta-analysis. J Bone Joint Surg Am 87(2):293–301. doi:10.2106/JBJS.D.01772

    Article  PubMed  Google Scholar 

  18. De Negri P, Tirri T, Paternoster G, Modano P (2007) Treatment of painful osteoporotic or traumatic vertebral compression fractures by percutaneous vertebral augmentation procedures: a nonrandomized comparison between vertebroplasty and kyphoplasty. Clin J Pain 23(5):425–430. doi:10.1097/AJP.0b013e31805593be

    Article  PubMed  Google Scholar 

  19. Fourney DR, Schomer DF, Nader R, Chlan-Fourney J, Suki D, Ahrar K, Rhines LD, Gokaslan ZL (2003) Percutaneous vertebroplasty and kyphoplasty for painful vertebral body fractures in cancer patients. J Neurosurg 98(1 Suppl):21–30

    PubMed  Google Scholar 

  20. Liu JT, Liao WJ, Tan WC, Lee JK, Liu CH, Chen YH, Lin TB (2010) Balloon kyphoplasty versus vertebroplasty for treatment of osteoporotic vertebral compression fracture: a prospective, comparative, and randomized clinical study. Osteoporos Int 21(2):359–364. doi:10.1007/s00198-009-0952-8

    Article  PubMed  CAS  Google Scholar 

  21. Rollinghoff M, Siewe J, Zarghooni K, Sobottke R, Alparslan Y, Eysel P, Delank KS (2009) Effectiveness, security and height restoration on fresh compression fractures—a comparative prospective study of vertebroplasty and kyphoplasty. Minim Invasive Neurosurg 52(5–6):233–237. doi:10.1055/s-0029-1243631

    Article  PubMed  CAS  Google Scholar 

  22. Grohs JG, Matzner M, Trieb K, Krepler P (2005) Minimal invasive stabilization of osteoporotic vertebral fractures: a prospective nonrandomized comparison of vertebroplasty and balloon kyphoplasty. J Spinal Disord Tech 18(3):238–242

    PubMed  Google Scholar 

  23. Schofer MD, Efe T, Timmesfeld N, Kortmann HR, Quante M (2009) Comparison of kyphoplasty and vertebroplasty in the treatment of fresh vertebral compression fractures. Arch Orthop Trauma Surg 129(10):1391–1399. doi:10.1007/s00402-009-0901-1

    Article  PubMed  Google Scholar 

  24. Lovi A, Teli M, Ortolina A, Costa F, Fornari M, Brayda-Bruno M (2009) Vertebroplasty and kyphoplasty: complementary techniques for the treatment of painful osteoporotic vertebral compression fractures. A prospective non-randomised study on 154 patients. Eur Spine J 18(Suppl 1):95–101. doi:10.1007/s00586-009-0986-9

    Article  PubMed  Google Scholar 

  25. Kumar K, Nguyen R, Bishop S (2010) A comparative analysis of the results of vertebroplasty and kyphoplasty in osteoporotic vertebral compression fractures. Neurosurgery 67(3 Suppl Operative):171–188. doi:10.1227/01.NEU.0000380936.00143.11, discussion p 188

    Google Scholar 

  26. Santiago FR, Abela AP, Alvarez LG, Osuna RM, Garcia Mdel M (2010) Pain and functional outcome after vertebroplasty and kyphoplasty. A comparative study. Eur J Radiol 75(2):e108–113. doi:10.1016/j.ejrad.2010.01.010

    Article  PubMed  Google Scholar 

  27. Yan D, Duan L, Li J, Soo C, Zhu H, Zhang Z (2010) Comparative study of percutaneous vertebroplasty and kyphoplasty in the treatment of osteoporotic vertebral compression fractures. Arch Orthop Trauma Surg. doi:10.1007/s00402-010-1188-y

    Google Scholar 

  28. Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359(9319):1761–1767. doi:10.1016/S0140-6736(02)08657-9

    Article  PubMed  Google Scholar 

  29. McKiernan F, Faciszewski T, Jensen R (2003) Reporting height restoration in vertebral compression fractures. Spine (Phila Pa 1976) 28(22):2517–2521. doi:10.1097/01.BRS.0000092424.29886.C9, discussion 2513

    Article  Google Scholar 

  30. Lieberman IH, Dudeney S, Reinhardt MK, Bell G (2001) Initial outcome and efficacy of "kyphoplasty" in the treatment of painful osteoporotic vertebral compression fractures. Spine (Phila Pa 1976) 26(14):1631–1638

    Article  CAS  Google Scholar 

  31. Garfin SR, Yuan HA, Reiley MA (2001) New technologies in spine: kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures. Spine (Phila Pa 1976) 26(14):1511–1515

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The intent of this statement is to display our idea on osteoporotic vertebral compression fracture. All the authors state that there are no outside grants in support of this research this work. There is no financial and personal relationships with other people or organisations that could inappropriately influence (bias) our work.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 Qingchun Road East, Hangzhou, Zhejiang, 310016, China

    Shiliang Han, Shuanglin Wan, Lei Ning, Yongjun Tong, Jianfeng Zhang & Shunwu Fan

Authors
  1. Shiliang Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shuanglin Wan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lei Ning
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yongjun Tong
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jianfeng Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shunwu Fan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shuanglin Wan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Han, S., Wan, S., Ning, L. et al. Percutaneous vertebroplasty versus balloon kyphoplasty for treatment of osteoporotic vertebral compression fracture: a meta-analysis of randomised and non-randomised controlled trials. International Orthopaedics (SICOT) 35, 1349–1358 (2011). https://doi.org/10.1007/s00264-011-1283-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-011-1283-x

Keywords

Search

Navigation