European Spine Journal

, Volume 16, Issue 8, pp 1085–1100 | Cite as

Balloon kyphoplasty in the management of vertebral compression fractures: an updated systematic review and meta-analysis

  • Rod S. Taylor
  • Peter Fritzell
  • Rebecca J. Taylor
Review Article


This systematic review updates the understanding of the evidence base for balloon kyphoplasty (BKP) in the management of vertebral compression fractures. Detailed searches of a number of electronic databases were performed from March to April 2006. Citation searches of included studies were undertaken and no language restrictions were applied. All controlled and uncontrolled studies were included with the exception of case reports. Prognostic factors responsible for pain relief and cement leakage were examined using meta-regression. Combined with previous evidence, a total of eight comparative studies (three against conventional medical therapy and five against vertebroplasty) and 35 case series were identified. The majority of studies were undertaken in older women with osteoporotic vertebral compression fractures with long-term pain that was refractory to medical treatment. In direct comparison to conventional medical management, patients undergoing BKP experienced superior improvements in pain, functionality, vertebral height and kyphotic angle at least up to 3-years postprocedure. Reductions in pain with BKP appeared to be greatest in patients with newer fractures. Uncontrolled studies suggest gains in health-related quality of life at 6 and 12-months following BKP. Although associated with a finite level of cement leakage, serious adverse events appear to be rare. Osteoporotic vertebral compression fractures appear to be associated with a higher level of cement leakage following BKP than non-osteoporotic vertebral compression fractures. In conclusion, there are now prospective studies of low bias, with follow-up of 12 months or more, which demonstrate balloon kyphoplasty to be more effective than medical management of osteoporotic vertebral compression fractures and as least as effective as vertebroplasty. Results from ongoing RCTs will provide further information in the near future.


Kyphoplasty Vertebral compression fractures Osteoporosis Systematic review Meta-analysis 


  1. 1.
    Borgstrom F, Zethraeus N, Johnell O, Lidgren L, Ponzer S, Svensson O, Abdon P, Ornstein E, Lunsjo K, Thorngren KG, Sernbo I, Rehnberg C, Jonsson B (2006) Costs and quality of life associated with osteoporosis-related fractures in Sweden. Osteoporos Int 17:637–650PubMedCrossRefGoogle Scholar
  2. 2.
    Bouza C, Lopez T, Magro A, Navalpotro L, Amate JM (2006) Efficacy and safety of balloon kyphoplasty in the treatment of vertebral compression fractures: a systematic review. Eur Spine J 21:1–18Google Scholar
  3. 3.
    Egger M, Smith GD, Phillips AN (1997) Meta-analysis: principles and procedures. BMJ 315:153–157Google Scholar
  4. 4.
    Egger M, Smith GD, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634PubMedGoogle Scholar
  5. 5.
    Finnern HW, Sykes DP (2003) The hospital cost of vertebral fractures in the EU: estimates using national datasets. Osteoporos Int 14:429–436PubMedCrossRefGoogle Scholar
  6. 6.
    Fribourg D, Yang C, Sra P, Delamarter R, Bae H (2004) Incidence of subsequent vertebral fractures after kyphoplasty. Spine 29:2270–2276PubMedCrossRefGoogle Scholar
  7. 7.
    Garfin SR, Yuan HA, Reiley MA (2001) New technologies in spine: kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures. Spine 26:1511–1515PubMedCrossRefGoogle Scholar
  8. 8.
    Garfin SR, Buckley RA, Ledlie J (2006) Balloon kyphoplasty for symptomatic vertebral body compression fractures results in rapid, significant, and sustained improvements in back pain, function, and quality of life for elderly patients. Spine (in press)Google Scholar
  9. 9.
    Hadjipavlou AG, Tzermiadianos MN, Katonis PG, Szpalski M (2005) Percutaneous vertebroplasty and balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures and osteolytic tumours. J Bone Joint Surg Br 87:1595–1604PubMedCrossRefGoogle Scholar
  10. 10.
    Higgins JPT, Green S (2005) Cochrane handbook for systematic reviews of interventions 4.2.5 (updated May 2005). In: The Cochrane library, issue 3. Wiley, Chichester, (last accessed 2nd January 2006)
  11. 11.
    Jarvik JG, Kallmes DF, Deyo RA (2006) Kyphoplasty: more answers or more questions? Spine 31:65–66PubMedCrossRefGoogle Scholar
  12. 12.
    Lieberman IH, Phillips FM, Togawa D, Modic M, Masaryk T, Obuchowski N, Slipman CW (2004) Vertebral augmentation and the limits of interpreting complications reported in the Food and Drug Administration Manufacturer and User Facility Device Experience Database. J Vasc Interv Radiol 15:1193–1196PubMedGoogle Scholar
  13. 13.
    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 website. J Vasc Interv Radiol 15:1185–1192PubMedGoogle Scholar
  14. 14.
    Ray NF, Chan JK, Thamer M, Melton LJ III (1997) Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995: report from the National Osteoporosis Foundation. J Bone Miner Res 12:24–35PubMedCrossRefGoogle Scholar
  15. 15.
    Roy DK, O’Neill TW, Finn JD, Lunt M, Silman AJ, Felsenberg D, Armbrecht G, Banzer D, Benevolenskaya LI, Bhalla A, Bruges Armas J, Cannata JB, Cooper C, Dequeker J, Diaz MN, Eastell R, Yershova OB, Felsch B, Gowin W, Havelka S, Hoszowski K, Ismail AA, Jajic I, Janott I, Johnell O, Kanis JA, Kragl G, Lopez Vaz A, Lorenc R, Lyritis G, Masaryk P, Matthis C, Miazgowski T, Gennari C, Pols HA, Poor G, Raspe HH, Reid DM, Reisinger W, Scheidt-Nave C, Stepan JJ, Todd CJ, Weber K, Woolf AD, Reeve J, for the European Prospective Osteoporosis Study (EPOS) (2003) Determinants of incident vertebral fracture in men and women: results from the European Prospective Osteoporosis Study (EPOS). Osteoporos Int 14:19–26Google Scholar
  16. 16.
    Taylor RS, Van Buyten JP, Buchser E. (2005) Spinal cord stimulation for chronic back and leg pain and failed back surgery syndrome: a systematic review and analysis of prognostic factors. Spine 30:152–160PubMedCrossRefGoogle Scholar
  17. 17.
    Taylor RS, Taylor RJ, Fritzell P (2007) Balloon kyphoplasty and vertebroplasty for vertebral compression fractures: a comparative systematic review of efficacy and safety. Spine (in press)Google Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Rod S. Taylor
    • 1
  • Peter Fritzell
    • 2
  • Rebecca J. Taylor
    • 3
  1. 1.Peninsula Medical SchoolUniversity of ExeterExeterUK
  2. 2.Department of Orthopaedic Surgery, Center of Clinical Research DalarnaFalun HospitalFalunSweden
  3. 3.Health Economics FacilityUniversity of BirminghamBirminghamUK

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