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Balloon kyphoplasty versus percutaneous vertebroplasty for treatment of osteoporotic vertebral compression fractures (OVCFs)

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Abstract

Summary

The study investigated whether kyphoplasty (KP) was superior to vertebroplasty (VP) in treating patients with osteoporotic vertebral compression fractures (OVCFs). KP may be superior to VP for treating patients with OVCFs based on long-term VAS and ODI but not short-term VAS. Further large-scale trials are needed to verify these findings due to potential risk of selection bias.

Introduction

This study aimed to assess whether KP was superior to VP in treating patients with OVCFs.

Methods

The Medline, Embase, and Cochrane databases and references within articles and proceedings of major meetings were systematically searched. Eligible studies included patients with OVCFs who received either KP or VP. Standard mean differences (SMDs) and relative risks (RRs) were used as measures of efficacy and safety in a random-effects model.

Results

Eleven studies enrolling 869 patients with OVCFs were identified as eligible for final analysis. Compared with VP, KP was associated with significant improvements in long-term (SMD, −0.70; 95 % confidence interval [CI]: −1.30, −0.10; P = 0.023) visual analog scale (VAS); short-term (SMD, −1.50; 95 % CI: −2.94, −0.07; P = 0.040) and long-term (SMD, −1.03; 95 % CI: −1.88, −0.18; P = 0.017) Oswestry Disability Indexes (ODIs); short-term (SMD, −0.74; 95 % CI: −1.42, −0.06; P = 0.032) and long-term (SMD, −0.71; 95 % CI: −1.19, −0.23; P = 0.004) kyphosis angles; and vertebral body height (SMD, 1.56; 95 % CI: 0.62, 2.49; P = 0.001) and anterior vertebral body height (SMD, 3.04; 95 % CI: 0.53, 5.56; P = 0.018). KP was also associated with a significantly longer operation time (SMD, 0.73; 95 % CI: 0.26, 1.19; P = 0.002) and a lower risk of cement extravasation (RR, 0.68; 95 % CI: 0.48, 0.96; P = 0.030) compared with VP. No significant differences were found in the short-term VAS, posterior vertebral body height, and adjacent-level fractures.

Conclusion

Acknowledging some risk of selection bias, KP displayed a significantly better performance compared with VP only in one of the two primary endpoints, that is, for ODI but not for short-term VAS. Further randomized studies are required to confirm these results.

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References

  1. Glaser DL, Kaplan FS (1997) Osteoporosis. Definition and clinical presentation. Spine (Phila Pa 1976) 22(24 Suppl):12S–16S

    Article  CAS  Google Scholar 

  2. Care SB (2013) Health technology assessment of scheduled procedures vertebroplasty and kyphoplasty for osteoporotic vertebral compression fractures

  3. Johnell O, Kanis J (2005) Epidemiology of osteoporotic fractures. Osteoporos Int 16(Suppl 2):S3–S7. doi:10.1007/s00198-004-1702-6

    Article  PubMed  Google Scholar 

  4. Karlsson MK, Hasserius R, Gerdhem P, Obrant KJ, Ohlin A(2005) Treatment of osteoporotic vertebral compression. Explosive interest for vertebroplasty and kyphoplasty. Lakartidningen 102(21):1644–6, 1648

  5. 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  CAS  PubMed  Google Scholar 

  6. Kim DH, Silber JS, Albert TJ (2003) Osteoporotic vertebral compression fractures. Instr Course Lect 52:541–550

    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. Ström O, Leonard C, Marsh D, Cooper C (2010) Cost-effectiveness of balloon kyphoplasty in patients with symptomatic vertebral compression fractures in a UK setting. Osteoporos Int 21(9):1599–1608. doi:10.1007/s00198-009-1096-6

    Article  PubMed  Google Scholar 

  9. Alexandru D, So W (2012) Evaluation and management of vertebral compression fractures. Perm J 16(4):46–51

    Article  PubMed  PubMed Central  Google Scholar 

  10. Staples MP, Kallmes DF, Comstock BA, Jarvik JG, Osborne RH, Heagerty PJ, Buchbinder R (2011) Effectiveness of vertebroplasty using individual patient data from two randomised placebo controlled trials: meta-analysis. BMJ 343:d3952. doi:10.1136/bmj.d3952

    Article  PubMed  PubMed Central  Google Scholar 

  11. Chandra RV, Yoo AJ, Hirsch JA (2013) Vertebral augmentation: update on safety, efficacy, cost effectiveness and increased survival? Pain Physician 16(4):309–320

    PubMed  Google Scholar 

  12. National Institute for Health and Clinical Excellence (2013) Percutaneous vertebroplasty and percutaneous balloon kyphoplasty for the treatment of osteoporotic vertebral fractures, NICE Technology Appraisal Guidance 279. National Institute for Health and Clinical Excellence, London

    Google Scholar 

  13. Malmivaara A, Hakkinen U, Aro T, Heinrichs ML, Koskenniemi L, Kuosma E, Lappi S, Paloheimo R, Servo C, Vaaranen V et al (1995) The treatment of acute low back pain—bed rest, exercises, or ordinary activity? N Engl J Med 332(6):351–355. doi:10.1056/NEJM199502093320602

    Article  CAS  PubMed  Google Scholar 

  14. Reginster J, Minne HW, Sorensen OH, Hooper M, Roux C, Brandi ML, Lund B, Ethgen D, Pack S, Roumagnac I, Eastell R (2000) Randomized trial of the effects of risedronate on vertebral fractures in women with established postmenopausal osteoporosis. Vertebral Efficacy with Risedronate Therapy (VERT) Study Group. Osteoporos Int 11(1):83–91

    Article  CAS  PubMed  Google Scholar 

  15. Kim DH, Vaccaro AR (2006) Osteoporotic compression fractures of the spine; current options and considerations for treatment. Spine J 6(5):479–487. doi:10.1016/j.spinee.2006.04.013

    Article  PubMed  Google Scholar 

  16. Qian Z, Sun Z, Yang H, Gu Y, Chen K, Wu G (2011) Kyphoplasty for the treatment of malignant vertebral compression fractures caused by metastases. J Clin Neurosci 18(6):763–767. doi:10.1016/j.jocn.2010.09.021

    Article  PubMed  Google Scholar 

  17. Boonen S, Van Meirhaeghe J, Bastian L, Cummings SR, Ranstam J, Tillman JB, Eastell R, Talmadge K, Wardlaw D (2011) Balloon kyphoplasty for the treatment of acute vertebral compression fractures: 2-year results from a randomized trial. J Bone Miner Res 26(7):1627–1637. doi:10.1002/jbmr.364

    Article  PubMed  Google Scholar 

  18. 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 16:1085–1100

    Article  PubMed  PubMed Central  Google Scholar 

  19. Gaitanis IN, Hadjipavlou AG, Katonis PG, Tzermiadianos MN, Pasku DS, Patwardhan AG (2005) Balloon kyphoplasty for the treatment of pathological vertebral compressive fractures. Eur Spine J 14(3):250–260. doi:10.1007/s00586-004-0767-4

    Article  PubMed  Google Scholar 

  20. Venmans A, Klazen CA, Lohle PN, van Rooij WJ, Verhaar HJ, de Vries J, Mali WP (2010) Percutaneous vertebroplasty and pulmonary cement embolism: results from VERTOS II. AJNR Am J Neuroradiol 31(8):1451–1453. doi:10.3174/ajnr.A2127

    Article  CAS  PubMed  Google Scholar 

  21. Wilson DJ (2011) Vertebroplasty for vertebral fracture. BMJ 343:d3470. doi:10.1136/bmj.d3470

    Article  PubMed  Google Scholar 

  22. Boonen S, Wahl DA, Nauroy L, Brandi ML, Bouxsein ML, Goldhahn J, Lewiecki EM, Lyritis GP, Marsh D, Obrant K, Silverman S, Siris E, Akesson K, Foundation CSAFWGoIO (2011) Balloon kyphoplasty and vertebroplasty in the management of vertebral compression fractures. Osteoporos Int 22(12):2915–2934. doi:10.1007/s00198-011-1639-5

    Article  CAS  PubMed  Google Scholar 

  23. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Plos Med 6:e1000097

    Article  PubMed  PubMed Central  Google Scholar 

  24. Shuster JJ (2011) Review: Cochrane handbook for systematic reviews for interventions, version 5.1.0, published 3/2011. Julian PT Higgins and Sally Green, Editors. Wiley Online Library

  25. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188

    Article  CAS  PubMed  Google Scholar 

  26. Higgins JPT, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560

    Article  PubMed  PubMed Central  Google Scholar 

  27. Tobias A (1999) Assessing the influence of a single study in meta-analysis. Stata Tech Bull 47:15–17

    Google Scholar 

  28. Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50:1088–1101

    Article  CAS  PubMed  Google Scholar 

  30. 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 

  31. Zhou JL, Liu SQ, Ming JH, Peng H, Qiu B (2008) Comparison of therapeutic effect between percutaneous vertebroplasty and kyphoplasty on vertebral compression fracture. Chin J Traumatol 11(1):42–44

    Article  PubMed  Google Scholar 

  32. 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  PubMed Central  Google Scholar 

  33. Röllinghoff 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  Google Scholar 

  34. 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 

  35. 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):ons171–ons188. doi:10.1227/01.NEU.0000380936.00143.11, discussion ons188

    PubMed  Google Scholar 

  36. Movrin I, Vengust R, Komadina R (2010) Adjacent vertebral fractures after percutaneous vertebral augmentation of osteoporotic vertebral compression fracture: a comparison of balloon kyphoplasty and vertebroplasty. Arch Orthop Trauma Surg 130(9):1157–1166. doi:10.1007/s00402-010-1106-3

    Article  CAS  PubMed  Google Scholar 

  37. Folman Y, Shabat S (2011) A comparison of two new technologies for percutaneous vertebral augmentation: confidence vertebroplasty vs. sky kyphoplasty. Isr Med Assoc J 13(7):394–397

    PubMed  Google Scholar 

  38. Qian J, Yang H, Jing J, Zhao H, Ni L, Tian D, Wang Z (2012) The early stage adjacent disc degeneration after percutaneous vertebroplasty and kyphoplasty in the treatment of osteoporotic VCFs. PLoS One 7(10):e46323. doi:10.1371/journal.pone.0046323

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Dong R, Chen L, Tang T, Gu Y, Luo Z, Shi Q, Li X, Zhou Q, Yang H (2013) Pain reduction following vertebroplasty and kyphoplasty. Int Orthop 37(1):83–87. doi:10.1007/s00264-012-1709-0

    Article  PubMed  Google Scholar 

  40. Farrokhi MR, Alibai E, Maghami Z (2011) Randomized controlled trial of percutaneous vertebroplasty versus optimal medical management for the relief of pain and disability in acute osteoporotic vertebral compression fractures. J Neurosurg Spine 14:561–569

    Article  PubMed  Google Scholar 

  41. Wang HK, Lu K, Liang CL, Weng HC, Wang KW, Tsai YD, Hsieh CH, Liliang PC (2010) Comparing clinical outcomes following percutaneous vertebroplasty with conservative therapy for acute osteoporotic vertebral compression fractures. Pain Med 11:1659–1665

    Article  PubMed  Google Scholar 

  42. Chen D, An ZQ, Song S, Tang JF, Qin H (2014) Percutaneous vertebroplasty compared with conservative treatment in patients with chronic painful osteoporotic spinal fractures. J Clin Neurosci 21:473–477

    Article  PubMed  Google Scholar 

  43. Lee HM, Park SY, Lee SH, Suh SW, Hong JY (2012) Comparative analysis of clinical outcomes in patients with osteoporotic vertebral compression fractures (OVCFs): conservative treatment versus balloon kyphoplasty. Spine J 12:998–1005

    Article  PubMed  Google Scholar 

  44. Song D, Meng B, Gan M, Niu J, Li S, Chen H, Yuan C, Yang H (2015) The incidence of secondary vertebral fracture of vertebral augmentation techniques versus conservative treatment for painful osteoporotic vertebral fractures: a systematic review and meta-analysis. Acta Radiol 56(8):970–979. doi:10.1177/0284185114544240

    Article  PubMed  Google Scholar 

  45. Buchbinder R, Osborne RH, Ebeling PR, Wark JD, Mitchell P, Wriedt C, Graves S, Staples MP, Murphy B (2009) A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med 361(6):557–568. doi:10.1056/NEJMoa0900429

    Article  CAS  PubMed  Google Scholar 

  46. 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 

  47. Xing D, Ma JX, Ma XL, Wang J, Xu WG, Chen Y, Song DH (2013) A meta-analysis of balloon kyphoplasty compared to percutaneous vertebroplasty for treating osteoporotic vertebral compression fractures. J Clin Neurosci 20(6):795–803. doi:10.1016/j.jocn.2012.05.038

    Article  PubMed  Google Scholar 

  48. 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(10):2222–2228

    CAS  PubMed  Google Scholar 

  49. Heini PF, Dain Allred C (2002) The use of a side-opening injection cannula in vertebroplasty: a technical note. Spine (Phila Pa 1976) 27(1):105–109

    Article  Google Scholar 

  50. Hsieh MK, Chen LH, Chen WJ (2013) Current concepts of percutaneous balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures: evidence-based review. Biomed J 36(4):154–161. doi:10.4103/2319-4170.112544

    Article  PubMed  Google Scholar 

  51. Schmidt R, Cakir B, Mattes T, Wegener M, Puhl W, Richter M (2005) Cement leakage during vertebroplasty: an underestimated problem? Eur Spine J 14(5):466–473. doi:10.1007/s00586-004-0839-5

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Choe DH, Marom EM, Ahrar K, Truong MT, Madewell JE (2004) Pulmonary embolism of polymethyl methacrylate during percutaneous vertebroplasty and kyphoplasty. AJR Am J Roentgenol 183(4):1097–1102. doi:10.2214/ajr.183.4.1831097

    Article  PubMed  Google Scholar 

  53. Chen WJ, Kao YH, Yang SC, Yu SW, Tu YK, Chung KC (2010) Impact of cement leakage into disks on the development of adjacent vertebral compression fractures. J Spinal Disord Tech 23(1):35–39. doi:10.1097/BSD.0b013e3181981843

    Article  PubMed  Google Scholar 

  54. Nussbaum DA, Gailloud P, Murphy K (2004) A review of complications associated with vertebroplasty and kyphoplasty as reported to the Food and Drug Administration medical device related web site. J Vasc Interv Radiol 15(11):1185–1192. doi:10.1097/01.RVI.0000144757.14780.E0

    Article  PubMed  Google Scholar 

  55. Fribourg D, Tang C, Sra P, Delamarter R, Bae H (2004) Incidence of subsequent vertebral fracture after kyphoplasty. Spine (Phila Pa 1976) 29(20):2270–2276, discussion 2277

    Article  Google Scholar 

  56. Wilson DJ, Owen S, Corkill RA (2011) Facet joint injections as a means of reducing the need for vertebroplasty in insufficiency fractures of the spine. Eur Radiol 21(8):1772–1778. doi:10.1007/s00330-011-2115-5

    Article  PubMed  Google Scholar 

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  1. Department of Orthopedics, the Beijing Army General Hospital, No. 5, Nanmengcang Lane, Beijing, 100700, People’s Republic of China

    G. Zhao, X. Liu & F. Li

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Zhao, G., Liu, X. & Li, F. Balloon kyphoplasty versus percutaneous vertebroplasty for treatment of osteoporotic vertebral compression fractures (OVCFs). Osteoporos Int 27, 2823–2834 (2016). https://doi.org/10.1007/s00198-016-3610-y

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