Skip to main content

Advertisement

Log in

Percutaneous vertebroplasty as a treatment for osteoporotic vertebral compression fractures: a systematic review

  • Review
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Percutaneous vertebroplasty has been performed for more than ten years to treat painful osteoporotic vertebral compression fractures. Clinical results have been encouraging, but little is known about the efficacy and safety of this minimally invasive procedure. We therefore performed a systematic review to assess the efficacy and safety of percutaneous vertebroplasty in osteoporotic vertebral compression fractures. A search was conducted using Medline, Embase and The Cochrane Controlled Trials Register. The search yielded fifteen studies, eleven prospective, three retrospective and one controlled trial. Totally 1,136 interventions were performed on 793 patients. Mean pain scores, measured using a 0 to 10 VAS score, improved significantly from 7.8 to 3.1 (−60.3%) immediately after percutaneous vertebroplasty. The short-term complication rate varied between 0.4 and 75.6%. Leakage of cement outside the vertebral body was markedly common, ranging from 3.3 to 75.6%. Although the majority was asymptomatic, a few devastating clinical adverse effects were reported (mean 2.4%). Although percutaneous vertebroplasty is a widely accepted treatment for osteoporotic vertebral fractures, we revealed only a single controlled trial. We conclude that there are insufficient data available to reliably assess efficacy of percutaneous vertebroplasty. The procedure has a low rate of clinical complications, but potential complications can be devastating. In the future, assessing the efficacy of percutaneous vertebroplasty requires controlled trials with long-term follow-up.

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

Access this article

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

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Alvarez L, Perez-Higueras A, Granizo JJ, de Miguel I, Quinones D, Rossi RE (2005) Predictors of outcomes of percutaneous vertebroplasty for osteoporotic vertebral fractures. Spine 30:87–92

    PubMed  Google Scholar 

  2. Bhatnagar MK, Mathur SK, Cruz-Oliverb E, Caceres E (2004) Percutaneous Vertebroplasty for the treatment of osteoporotic vertebral compression fractures. Revista de Ortopedia y Traumatologia 48:186–194

    Google Scholar 

  3. Black DM, Arden NK, Palermo L, Pearson J, Cummings SR (1999) Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. Study of Osteoporotic Fractures Research Group. J Bone Miner Res 14:821–828

    Article  PubMed  CAS  Google Scholar 

  4. Burger H, Van Daele PL, Grashuis K, Hofman A, Grobbee DE, Schutte HE, Birkenhager JC, Pols HA (1997) Vertebral deformities and functional impairment in men and women. J Bone Miner Res 12:152–157

    Article  PubMed  CAS  Google Scholar 

  5. Cauley JA, Thompson DE, Ensrud KC, Scott JC, Black D (2000) Risk of mortality following clinical fractures. Osteoporos Int 11:556–561

    Article  PubMed  CAS  Google Scholar 

  6. Chen JF, Lee ST, Lui TN, Wu CT, Liao CC (2002) Percutaneous vertebroplasty for the treatment of osteoporotic vertebral compression fractures: a preliminary report. Chang Gung Med J 25:306–314

    PubMed  Google Scholar 

  7. Chen LH, Niu CC, Yu SW, Fu TS, Lai PL, Chen WJ (2004) Minimally invasive treatment of osteoporotic vertebral compression fracture. Chang Gung Med J 27:261–267

    PubMed  Google Scholar 

  8. Consensus Development Group Osteoporosis (1993) Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med 94:646–650

    Article  Google Scholar 

  9. Cook DJ, Guyatt GH, Adachi JD, Clifton J, Griffith LE, Epstein RS, Juniper EF (1993) Quality of life issues in women with vertebral fractures due to osteoporosis. Arthritis Rheum 36:750–756

    PubMed  CAS  Google Scholar 

  10. Cooper C, Atkinson EJ, O’Fallon WM, Melton LJ III (1992) Incidence of clinically diagnosed vertebral fractures: a population-based study in Rochester, Minnesota, 1985–1989. J Bone Miner Res 7:221–227

    PubMed  CAS  Google Scholar 

  11. Cortet B, Cotten A, Boutry N, Flipo RM, Duquesnoy B, Chastanet P, Delcambre B (1999) Percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures: an open prospective study. J Rheumatol 26:2222–2228

    PubMed  CAS  Google Scholar 

  12. Cyteval C, Sarrabere MP, Roux JO, Thomas E, Jorgensen C, Blotman F, Sany J, Taourel P (1999) Acute osteoporotic vertebral collapse: open study on percutaneous injection of acrylic surgical cement in 20 patients. AJR Am J Roentgenol 173:1685–1690

    PubMed  CAS  Google Scholar 

  13. Diamond TH, Champion B, Clark WA (2003) Management of acute osteoporotic vertebral fractures: a nonrandomized trial comparing percutaneous vertebroplasty with conservative therapy. Am J Med 114:257–265

    Article  PubMed  Google Scholar 

  14. Dreinhofer KE, Feron JM, Herrera A, Hube R, Johnell O, Lidgren L, Miles K, Panarella L, Simpson H, Wallace WA (2004) Orthopaedic surgeons and fragility fractures. A survey by the bone and joint decade and the International Osteoporosis Foundation. J Bone Joint Surg Br 86:958–961

    Article  PubMed  CAS  Google Scholar 

  15. EPOS Group (2002) Incidence of vertebral fracture in Europe: results from the European Prospective Osteoporosis Study (EPOS). J Bone Miner Res 17:716–724

    Article  Google Scholar 

  16. Ettinger B, Black DM, Nevitt MC, Rundle AC, Cauley JA, Cummings SR, Genant HK (1992) Contribution of vertebral deformities to chronic back pain and disability. The study of Osteoporotic Fractures Research Group. J Bone Miner Res 7:449–456

    PubMed  CAS  Google Scholar 

  17. Evans AJ, Jensen ME, Kip KE, DeNardo AJ, Lawler GJ, Negin GA, Remley KB, Boutin SM, Dunnagan SA (2003) Vertebral compression fractures: pain reduction and improvement in functional mobility after percutaneous polymethylmethacrylate vertebroplasty retrospective report of 245 cases. Radiology 226:366–372

    PubMed  Google Scholar 

  18. Fairbank JC, Couper J, Davies JB, O’Brien JP (1980) The Oswestry low back pain disability questionnaire. Physiotherapy 66:271–273

    PubMed  CAS  Google Scholar 

  19. Galibert P, Deramond H, Rosat P, Le Gars D (1987) [Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty]. Neurochirurgie 33:166–168

    PubMed  CAS  Google Scholar 

  20. Genant HK, Li J, Wu CY, Shepherd JA (2000) Vertebral fractures in osteoporosis: a new method for clinical assessment. J Clin Densitom 3:281–290

    Article  PubMed  CAS  Google Scholar 

  21. Grados F, Depriester C, Cayrolle G, Hardy N, Deramond H, Fardellone P (2000) Long-term observations of vertebral osteoporotic fractures treated by percutaneous vertebroplasty. Rheumatology (Oxford) 39:1410–1414

    Article  CAS  Google Scholar 

  22. Heini PF, Walchli B, Berlemann U (2000) Percutaneous transpedicular vertebroplasty with PMMA: operative technique and early results. A prospective study for the treatment of osteoporotic compression fractures. Eur Spine J 9:445–450

    Article  PubMed  CAS  Google Scholar 

  23. Hunt SM, McEwen J, McKenna SP (1985) Measuring health status: a new tool for clinicians and epidemiologists. J R Coll Gen Pract 35:185–188

    PubMed  CAS  Google Scholar 

  24. Huskisson EC (1974) Measurement of pain. Lancet 2:1127–1131

    Article  PubMed  CAS  Google Scholar 

  25. Jensen ME, Evans AJ, Mathis JM, Kallmes DF, Cloft HJ, Dion JE (1997) Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures: technical aspects. AJNR Am J Neuroradiol 18:1897–1904

    PubMed  CAS  Google Scholar 

  26. Kado DM, Browner WS, Palermo L, Nevitt MC, Genant HK, Cummings SR (1999) Vertebral fractures and mortality in older women: a prospective study. Study of Osteoporotic Fractures Research Group. Arch Intern Med 159:1215–1220

    Article  PubMed  CAS  Google Scholar 

  27. Kallmes DF, Schweickert PA, Marx WF, Jensen ME (2002) Vertebroplasty in the mid- and upper thoracic spine. AJNR Am J Neuroradiol 23:1117–1120

    PubMed  Google Scholar 

  28. Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA III, Berger M (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15:721–739

    Article  PubMed  CAS  Google Scholar 

  29. Kobayashi K, Shimoyama K, Nakamura K, Murata K (2005) Percutaneous vertebroplasty immediately relieves pain of osteoporotic vertebral compression fractures and prevents prolonged immobilization of patients. Eur Radiol 15:360–367

    Article  PubMed  Google Scholar 

  30. Kotowicz MA, Melton LJ III, Cooper C, Atkinson EJ, O’Fallon WM, Riggs BL (1994) Risk of hip fracture in women with vertebral fracture. J Bone Miner Res 9:599–605

    Article  PubMed  CAS  Google Scholar 

  31. Legroux-Gerot I, Lormeau C, Boutry N, Cotten A, Duquesnoy B, Cortet B (2004) Long-term follow-up of vertebral osteoporotic fractures treated by percutaneous vertebroplasty. Clin Rheumatol 23:310–317

    Article  PubMed  Google Scholar 

  32. Leidig G, Minne HW, Sauer P, Wuster C, Wuster J, Lojen M, Raue F, Ziegler R (1990) A study of complaints and their relation to vertebral destruction in patients with osteoporosis. Bone Miner 8:217–229

    Article  PubMed  CAS  Google Scholar 

  33. Leidig-Bruckner G, Minne HW, Schlaich C, Wagner G, Scheidt-Nave C, Bruckner T, Gebest HJ, Ziegler R (1997) Clinical grading of spinal osteoporosis: quality of life components and spinal deformity in women with chronic low back pain and women with vertebral osteoporosis. J Bone Miner Res 12:663–675

    Article  PubMed  CAS  Google Scholar 

  34. Liliang PC, Su TM, Liang CL, Chen HJ, Tsai YD, Lu K (2005) Percutaneous vertebroplasty improves pain and physical functioning in elderly osteoporotic vertebral compression fracture patients. Gerontology 51:34–39

    Article  PubMed  Google Scholar 

  35. Lindsay R, Silverman SL, Cooper C, Hanley DA, Barton I, Broy SB, Licata A, Benhamou L, Geusens P, Flowers K, Stracke H, Seeman E (2001) Risk of new vertebral fracture in the year following a fracture. JAMA 285:320–323

    Article  PubMed  CAS  Google Scholar 

  36. Lips P, Cooper C, Agnusdei D, Caulin F, Egger P, Johnell O, Kanis JA, Kellingray S, Leplege A, Liberman UA, McCloskey E, Minne H, Reeve J, Reginster JY, Scholz M, Todd C, de Vernejoul MC, Wiklund I (1999) Quality of life in patients with vertebral fractures: validation of the quality of life questionnaire of the European Foundation for Osteoporosis (QUALEFFO). Working party for quality of life of the European Foundation for Osteoporosis. Osteoporos Int 10:150–160

    Article  PubMed  CAS  Google Scholar 

  37. Lyles KW, Gold DT, Shipp KM, Pieper CF, Martinez S, Mulhausen PL (1993) Association of osteoporotic vertebral compression fractures with impaired functional status. Am J Med 94:595–601

    Article  PubMed  CAS  Google Scholar 

  38. Mahoney FI, Barthel DW 1965() Functional evaluation: the barthel index. Md State Med J 14:61–65

    PubMed  CAS  Google Scholar 

  39. Martin JB, Jean B, Sugiu K, San Millan RD, Piotin M, Murphy K, Rufenacht B, Muster M, Rufenacht DA (1999) Vertebroplasty: clinical experience and follow-up results. Bone 25:11S–15S

    Article  PubMed  CAS  Google Scholar 

  40. McGraw JK, Lippert JA, Minkus KD, Rami PM, Davis TM, Budzik RF (2002) Prospective evaluation of pain relief in 100 patients undergoing percutaneous vertebroplasty: results and follow-up. J Vasc Interv Radiol 13:883–886

    PubMed  Google Scholar 

  41. McKiernan F, Faciszewski T, Jensen R (2004) Quality of life following vertebroplasty. J Bone Joint Surg Am 86-A:2600–2606

    PubMed  Google Scholar 

  42. Melton LJ III (1997) Epidemiology of spinal osteoporosis. Spine 22:2S–11S

    Article  PubMed  Google Scholar 

  43. Nevitt MC, Thompson DE, Black DM, Rubin SR, Ensrud K, Yates AJ, Cummings SR (2000) Effect of alendronate on limited-activity days and bed-disability days caused by back pain in postmenopausal women with existing vertebral fractures. Fracture Intervention Trial Research Group. Arch Intern Med 160:77–85

    Article  PubMed  CAS  Google Scholar 

  44. Osteoporosis Quality of Life Study Group (1997) Measuring quality of life in women with osteoporosis. Osteoporos Int 7:478–487

    Article  Google Scholar 

  45. Perez-Higueras A, Alvarez L, Rossi RE, Quinones D, Al Assir I (2002) Percutaneous vertebroplasty: long-term clinical and radiological outcome. Neuroradiology 44:950–954

    Article  PubMed  CAS  Google Scholar 

  46. Pluijm SM, Tromp AM, Smit JH, Deeg DJ, Lips P (2000) Consequences of vertebral deformities in older men and women. J Bone Miner Res 15:1564–1572

    Article  PubMed  CAS  Google Scholar 

  47. Rao RD, Singrakhia MD (2003) Painful osteoporotic vertebral fracture. Pathogenesis, evaluation, and roles of vertebroplasty and kyphoplasty in its management. J Bone Joint Surg Am 85-A:2010–2022

    PubMed  Google Scholar 

  48. Ross PD, Davis JW, Epstein RS, Wasnich RD (1991) Pre-existing fractures and bone mass predict vertebral fracture incidence in women. Ann Intern Med 114:919–923

    PubMed  CAS  Google Scholar 

  49. Schlaich C, Minne HW, Bruckner T, Wagner G, Gebest HJ, Grunze M, Ziegler R, Leidig-Bruckner G (1998) Reduced pulmonary function in patients with spinal osteoporotic fractures. Osteoporos Int 8:261–267

    Article  PubMed  CAS  Google Scholar 

  50. Shekelle PG, Woolf SH, Eccles M, Grimshaw J (1999) Clinical guidelines: developing guidelines. BMJ 318:593–596

    PubMed  CAS  Google Scholar 

  51. Tsou IY, Goh PY, Peh WC, Goh LA, Chee TS (2002) Percutaneous vertebroplasty in the management of osteoporotic vertebral compression fractures: initial experience. Ann Acad Med Singapore 31:15–20

    PubMed  CAS  Google Scholar 

  52. Van Tulder MW, Assendelft WJ, Koes BW, Bouter LM (1997) Method guidelines for systematic reviews in the Cochrane Collaboration Back Review Group for Spinal Disorders. Spine 22:2323–2330

    Article  PubMed  Google Scholar 

  53. Voormolen MH, Lohle PN, Fransen H, Juttmann JR, de Waal MJ, Lampmann LE (2003) [Percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures: first short term results]. Ned Tijdschr Geneeskd 147:1549–1553

    PubMed  CAS  Google Scholar 

  54. Wilson DR, Myers ER, Mathis JM, Scribner RM, Conta JA, Reiley MA, Talmadge KD, Hayes WC (2000) Effect of augmentation on the mechanics of vertebral wedge fractures. Spine 25:158–165

    Article  PubMed  CAS  Google Scholar 

  55. Winking M, Stahl JP, Oertel M, Schnettler R, Boker DK (2004) Treatment of pain from osteoporotic vertebral collapse by percutaneous PMMA vertebroplasty. Acta Neurochir (Wien ) 146:469–476

    Article  CAS  Google Scholar 

  56. Zoarski GH, Snow P, Olan WJ, Stallmeyer MJ, Dick BW, Hebel JR, De Deyne M (2002) Percutaneous vertebroplasty for osteoporotic compression fractures: quantitative prospective evaluation of long-term outcomes. J Vasc Interv Radiol 13:139–148

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Maurits S. Sietsma.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ploeg, W.T., Veldhuizen, A.G., The, B. et al. Percutaneous vertebroplasty as a treatment for osteoporotic vertebral compression fractures: a systematic review. Eur Spine J 15, 1749–1758 (2006). https://doi.org/10.1007/s00586-006-0159-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-006-0159-z

Keywords

Navigation