European Spine Journal

, Volume 21, Issue 9, pp 1826–1843 | Cite as

Comparing effects of kyphoplasty, vertebroplasty, and non-surgical management in a systematic review of randomized and non-randomized controlled studies

  • Ioannis D. Papanastassiou
  • Frank M. Phillips
  • Jan Van Meirhaeghe
  • James R. Berenson
  • Gunnar B. J. Andersson
  • Gary Chung
  • Brent J. Small
  • Kamran Aghayev
  • Frank D. Vrionis
Review Article



To determine if differences in safety or efficacy exist between balloon kyphoplasty (BKP), vertebroplasty (VP) and non-surgical management (NSM) for the treatment of osteoporotic vertebral compression fractures (VCFs).


As of February 1, 2011, a PubMed search (key words: kyphoplasty, vertebroplasty) resulted in 1,587 articles out of which 27 met basic selection criteria (prospective multiple-arm studies with cohorts of ≥20 patients). This systematic review adheres to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines.


Pain reduction in both BKP (−5.07/10 points, P < 0.01) and VP (−4.55/10, P < 0.01) was superior to that for NSM (−2.17/10), while no difference was found between BKP/VP (P = 0.35). Subsequent fractures occurred more frequently in the NSM group (22 %) compared with VP (11 %, P = 0.04) and BKP (11 %, P = 0.01). BKP resulted in greater kyphosis reduction than VP (4.8º vs. 1.7°, P < 0.01). Quality of life (QOL) improvement showed superiority of BKP over VP (P = 0.04), along with a trend for disability improvement (P = 0.08). Cement extravasation was less frequent in the BKP (P = 0.01). Surgical intervention within the first 7 weeks yielded greater pain reduction than VCFs treated later.


BKP/VP provided greater pain relief and fewer subsequent fractures than NSM in osteoporotic VCFs. BKP is marginally favored over VP in disability improvement, and significantly favored in QOL improvement. BKP had a lower risk of cement extravasation and resulted in greater kyphosis correction. Despite this analysis being restricted to Level I and II studies, significant heterogeneity suggests that the current literature is delivering inconsistent messages and further trials are needed to delineate confounding variables.


Vertebral compression fractures Osteoporosis Balloon kyphoplasty Vertebroplasty Systematic review 



Vertebral compression fracture(s)


Balloon kyphoplasty




Vertebral augmentation procedures


Non-surgical management


Randomized controlled trial(s)


Preferred reporting items for systematic reviews and meta-analyses


Indirect treatment comparisons


Rolland morris disability


Oswestry disability index


Quality of life


Physical component summary


Visual analog scale


Serious adverse event(s)



We thank Mohammed Eleraky, MD (Moffitt Cancer Center, Tampa, FL) for validation and verification of the extracted data.

Conflict of interest

Frank M. Phillips, Jan Van Meirhaeghe, James R. Berenson and Frank D. Vrionis are consultants for Medtronic and have received grants and honoraria. Brent J. Small and Gary Chung were paid from Medtronic to conduct an independent statistical analysis.


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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Ioannis D. Papanastassiou
    • 1
    • 2
  • Frank M. Phillips
    • 6
  • Jan Van Meirhaeghe
    • 3
  • James R. Berenson
    • 7
  • Gunnar B. J. Andersson
    • 6
  • Gary Chung
    • 4
  • Brent J. Small
    • 5
  • Kamran Aghayev
    • 1
  • Frank D. Vrionis
    • 1
  1. 1.H. Lee Moffitt Cancer Center and Research Institute, NeuroOncology Program and Department of Neurosurgery and OrthopaedicsUniversity of South Florida College of MedicineTampaUSA
  2. 2.Department of OrthopedicsGeneral Oncological Hospital “Agioi Anargyroi”AthensGreece
  3. 3.Dienst Orthopedie en TraumatologieAlgemeen Ziekenhuis Sint-Jan Brugge-Oostende AVBruggeBelgium
  4. 4.Medtronic Spinal and Biologics, Kyphon Products DivisionSunnyvaleUSA
  5. 5.School of Aging StudiesUniversity of South FloridaTampaUSA
  6. 6.Department of OrthopedicsRush University Medical CenterChicagoUSA
  7. 7.Institute for Myeloma and Bone Cancer ResearchWest HollywoodUSA

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