Skip to main content

Advertisement

SpringerLink
Log in

Percutaneous vertebroplasty versus non-operative treatment for osteoporotic vertebral compression fractures: a meta-analysis of randomized controlled trials

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

Abstract

Purpose

Osteoporotic vertebral compression fractures (OVCFs) are common in the elderly population and are often treated using percutaneous vertebroplasty (PVP). However, the effectiveness of PVP reported by various randomized controlled trials (RCTs) is inconclusive. This study aimed to analyze, from published literature, the efficacy and safety of PVP for OVCFs.

Methods

A search was conducted in Medline, EMBASE, and Cochrane Libraries since their respective inception on January 1, 2019, for RCTs of OVCFs treated with PVP compared with non-operative treatment. The primary outcomes were pain relief at 1 to 2 weeks, 1 to 3 months, and 6 to 12 months. The secondary outcome was the rate of occurrence of new vertebral fractures. Meta-analysis was performed using a random effect model.

Results

A total of 13 RCTs comprising 1624 patients were included. For the blinded studies, statistical differences were found between PVP and the sham injection group for the 3 primary outcomes in the subgroup of the Vertebroplasty for Acute Painful Osteoporotic fractURes (VAPOUR) trial. Although pain scores were similar between the PVP group and the sham injection group for the VAPOUR trial at each period, the effect size of PVP increased over time. For the open-label studies, PVP significantly reduced pain at all time points. The risk of new vertebral fractures was similar between the PVP groups and control groups.

Conclusions

Application of PVP was effective and safe only in patients with acute OVCFs having persistent and severe pain. No benefits were recorded, among patients with older fractures or those bearing non-severe symptoms.

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

Similar content being viewed by others

References

  1. Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17(12):1726–1733

    Article  CAS  PubMed  Google Scholar 

  2. Jones G, White C, Nguyen T, Sambrook PN, Kelly PJ, Eisman JA (1996) Prevalent vertebral deformities: relationship to bone mineral density and spinal osteophytosis in elderly men and women. Osteoporos Int 6:233–239

    Article  CAS  PubMed  Google Scholar 

  3. Borgström F, Olafsson G, Ström O, Tillman JB, Wardlaw D, Boonen S, Miltenburger C (2013) The impact of different health dimensions on overall quality of life related to kyphoplasty and non-surgical management. Osteoporos Int 24:1991–1999

    Article  PubMed  Google Scholar 

  4. Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR (2009) Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA 301:513–521

    Article  CAS  PubMed  Google Scholar 

  5. Prather H, Watson JO, Gilula LA (2007) Nonoperative management of osteoporotic vertebral compression fractures. Injury 38(Suppl 3):S40–S48

    Article  PubMed  Google Scholar 

  6. Kanis JA, Johnell O (1999) The burden of osteoporosis. J Endocrinol Investig 22:583–588

    Article  CAS  Google Scholar 

  7. Goldstein CL, Chutkan NB, Choma TJ, Orr RD (2015) Management of the elderly with vertebral compression fractures. Neurosurgery 77(Suppl 4):S33–S45

    Article  PubMed  Google Scholar 

  8. 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(4):257–265

    Article  PubMed  Google Scholar 

  9. 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(32):1549–1553

    CAS  PubMed  Google Scholar 

  10. Voormolen MH, van Rooij WJ, van der Graaf Y, Lohle PN, Lampmann LE, Juttmann JR, Sluzewski M (2006) Bone marrow edema in osteoporotic vertebral compression fractures after percutaneous vertebroplasty and relation with clinical outcome. AJNR Am J Neuroradiol 27(5):983–988

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Alvarez L, Alcaraz M, Pérez-Higueras A, Granizo JJ, de Miguel I, Rossi RE, Quiñones D (2006) Percutaneous vertebroplasty: functional improvement in patients with osteoporotic compression fractures. Spine (Phila Pa 1976) 31:1113–1118

    Article  Google Scholar 

  12. 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(11):1659–1665

    Article  PubMed  Google Scholar 

  13. Rousing R, Andersen MO, Jespersen SM, Thomsen K, Lauritsen J (2009) Percutaneous vertebroplasty compared to conservative treatment in patients with painful acute or subacute osteoporotic vertebral fractures: three-months follow-up in a clinical randomized study. Spine (Phila Pa 1976) 34:1349–1354

    Article  Google Scholar 

  14. Voormolen MH, Mali WP, Lohle PN, Fransen H, Lampmann LE, van der Graaf Y, Juttmann JR, Jansssens X, Verhaar HJ (2007) Percutaneous vertebroplasty compared with optimal pain medication treatment: short-term clinical outcome of patients with subacute or chronic painful osteoporotic vertebral compression fractures. The VERTOS study. AJNR Am J Neuroradiol 28:555–560

    CAS  PubMed  PubMed Central  Google Scholar 

  15. Kallmes DF, Comstock BA, Heagerty PJ, Turner JA, Wilson DJ, Diamond TH, Edwards R, Gray LA, Stout L, Owen S, Hollingworth W, Ghdoke B, Annesley-Williams DJ, Ralston SH, Jarvik JG (2009) A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med 361:569–579

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. 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 361:557–568

    Article  CAS  PubMed  Google Scholar 

  17. Uppin AA, Hirsch JA, Centenera LV, Pfiefer BA, Pazianos AG, Choi IS (2003) Occurrence of new vertebral body fracture after percutaneous vertebroplasty in patients with osteoporosis. Radiology 226:119–124

    Article  PubMed  Google Scholar 

  18. Kim SH, Kang HS, Choi JA, Ahn JM (2004) Risk factors of new compression fractures in adjacent vertebrae after percutaneous vertebroplasty. Acta Radiol 45:440–445

    Article  CAS  PubMed  Google Scholar 

  19. Esses SI, McGuire R, Jenkins J, Finkelstein J, Woodard E, Watters WC III, Goldberg MJ, Keith M, Turkelson CM, Wies JL, Sluka P, Boyer KM, Hitchcock K (2011) The treatment of symptomatic osteoporotic spinal compression fractures. J Am Acad Orthop Surg 19(3):176–182

    Article  PubMed  Google Scholar 

  20. Xie L, Zhao ZG, Zhang SJ, Hu YB (2017) Percutaneous vertebroplasty versus conservative treatment for osteoporotic vertebral compression fractures: an updated meta-analysis of prospective randomized controlled trials. Int J Surg 47:25–32

    Article  PubMed  Google Scholar 

  21. Mattie R, Laimi K, Yu S, Saltychev M (2016) Comparing percutaneous vertebroplasty and conservative therapy for treating osteoporotic compression fractures in the thoracic and lumbar spine: a systematic review and meta-analysis. J Bone Joint Surg Am 98:1041–1051

    Article  PubMed  Google Scholar 

  22. Tian J, Xiang L, Zhou D, Fan Q, Ma B (2014) The clinical efficacy of vertebroplasty on osteoporotic vertebral compression fracture: a meta-analysis. Int J Surg 12:1249–1253

    Article  PubMed  Google Scholar 

  23. Liu J, Li X, Tang D, Cui X, Li X, Yao M, Yu P, Qian X, Wang Y, Jiang H (2013) Comparing pain reduction following vertebroplasty and conservative treatment for osteoporotic vertebral compression fractures: a meta-analysis of randomized controlled trials. Pain Physician 16:455–464

    PubMed  Google Scholar 

  24. Shi MM, Cai XZ, Lin T, Wang W, Yan SG (2012) Is there really no benefit of vertebroplasty for osteoporotic vertebral fractures? A meta-analysis. Clin Orthop Relat Res 470:2785–2799

    Article  PubMed  PubMed Central  Google Scholar 

  25. Hansen EJ, Simony A, Rousing R, Carreon LY, Tropp H, Andersen MØ (2016) Double blind placebo-controlled trial of percutaneous vertebroplasty (VOPE). Global Spine Journal 6(1_suppl):s-0036-1582763

    Article  Google Scholar 

  26. Leali PT, Solla F, Maestretti G, Balsano M, Doria C (2016) Safety and efficacy of vertebroplasty in the treatment of osteoporotic vertebral compression fractures: a prospective multicenter international randomized controlled study. Clin Cases Miner Bone Metab 13(3):234–236

    PubMed  Google Scholar 

  27. Firanescu CE, de Vries J, Lodder P, et al. Vertebroplasty versus sham procedure for painful acute osteoporotic vertebral compression fractures (VERTOS IV): randomised sham controlled clinical trial. BMJ. 2018. 361(no pagination): k1551

  28. Clark W, Bird P, Gonski P, Diamond TH, Smerdely P, McNeil HP, Schlaphoff G, Bryant C, Barnes E, Gebski V (2016) Safety and efficacy of vertebroplasty for acute painful osteoporotic fractures (VAPOUR): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet 388(10052):1408–1416

    Article  PubMed  Google Scholar 

  29. Higgins JPT, Green S (eds) (2011) Cochrane Handbook for systematic reviews of interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org

  30. Akl EA, Sun X, Busse JW, Johnston BC, Briel M, Mulla S, You JJ, Bassler D, Lamontagne F, Vera C, Alshurafa M, Katsios CM, Heels-Ansdell D, Zhou Q, Mills E, Guyatt GH (2012) Specific instructions for estimating unclearly reported blinding status in randomized trials were reliable and valid. J Clin Epidemiol 65(3):262–267

    Article  PubMed  Google Scholar 

  31. Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD et al (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928

    Article  PubMed  PubMed Central  Google Scholar 

  32. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7(3):177–188

    Article  CAS  PubMed  Google Scholar 

  33. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560

    Article  PubMed  PubMed Central  Google Scholar 

  34. Egger M, Davey SG, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315(7109):629–634

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Yang EZ, Xu JG, Huang GZ, Xiao WZ, Liu XK, Zeng BF, Lian XF (2016) Percutaneous vertebroplasty versus conservative treatment in aged patients with acute osteoporotic vertebral compression fractures: a prospective randomized controlled clinical study. Spine (Phila Pa 1976) 41:653–660

    Article  Google Scholar 

  36. 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 

  37. Blasco J, Martinez-Ferrer A, Macho J, San RL, Pomés J, Carrasco J, Monegal A, Guañabens N, Peris P (2012) Effect of vertebroplasty on pain relief, quality of life, and the incidence of new vertebral fractures: a 12-month randomized follow-up, controlled trial. J Bone Miner Res 27:1159–1166

    Article  PubMed  Google Scholar 

  38. 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 

  39. 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 376:1085–1092

    Article  PubMed  Google Scholar 

  40. Gotzsche PC (2000) Why we need a broad perspective on meta-analysis. It may be crucially important for patients. BMJ 321:585–586

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Buchbinder R, Johnston RV, Rischin KJ, Homik J, Jones CA, Golmohammadi K, Kallmes DF (2018) Percutaneous vertebroplasty for osteoporotic vertebral compression fracture. Cochrane Database Syst Rev 4:CD006349

    PubMed  Google Scholar 

  42. Katz NP, Paillard FC, Ekman E (2015) Determining the clinical importance of treatment benefits for interventions for painful orthopedic conditions. J Orthop Surg Res 10:24

    Article  PubMed  PubMed Central  Google Scholar 

  43. Clark W, Bird P, Diamond T, Gonski P, Gebski V (2019) Cochrane vertebroplasty review misrepresented evidence for vertebroplasty with early intervention in severely affected patients. BBMJ Evidence-Based Medicine Published Online First: 09 March 2019. https://doi.org/10.1136/bmjebm-2019-111171

  44. Farrar JT, Portenoy RK, Berlin JA, Kinman JL, Strom BL (2000) Defining the clinically important difference in pain outcome measures. Pain 88:287–294

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Spine Surgery, The First Affiliated Hospital of Harbin Medical University, No. 23 Youzheng Road, Harbin, 150001, Heilongjiang, People’s Republic of China

    S. Lou, X. Shi, X. Zhang & Y. Wang

  2. Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China

    H. Lyu & Z. Li

Authors
  1. S. Lou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. X. Shi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. X. Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H. Lyu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Z. Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Y. Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Y. Wang.

Ethics declarations

Competing interests

The authors declare that they have no competing interests.

Ethics approval and consent to participate

Not applicable.

Conflicts of interest

None.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lou, S., Shi, X., Zhang, X. et al. Percutaneous vertebroplasty versus non-operative treatment for osteoporotic vertebral compression fractures: a meta-analysis of randomized controlled trials. Osteoporos Int 30, 2369–2380 (2019). https://doi.org/10.1007/s00198-019-05101-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-019-05101-8

Keywords

Search

Navigation