Is There Really No Benefit of Vertebroplasty for Osteoporotic Vertebral Fractures? A Meta-analysis
- 664 Downloads
Osteoporotic vertebral compressed fractures (VCFs) are the most common osteoporotic fractures. Although percutaneous vertebroplasty (PVP) reportedly relieves pain and improves function, a recent pooled analysis from two multicenter randomized controlled trials concluded the improvement in pain and disability treated with PVP was similar to those with sham surgery.
Using meta-analysis we therefore asked whether compared with either nonoperative therapy or a sham injection for patients with VCF, PVP would (1) better relieve pain, (2) provide greater improvement in pain-related disability, and (3) increase the recurrence of vertebral fractures.
We searched PubMed, EMBASE, Medline, and the Cochrane library using the keywords “vertebroplasty AND osteoporosis OR fracture”. We included nine of the 469 articles identified. Using a random effects model, we calculated the weighted mean differences to evaluate the pain reduction at different times as the primary outcome. Pain-related disability was assessed by a quality of life (QOL) measure. Improvement of QOL and recurrence of vertebral fractures were the secondary outcomes. We used subgroup analysis to reinvestigate pain relief and function improvement of PVP based on two different controls: nonoperative therapy and sham injection. The total number of patients was 886.
Pain scoring was similar between the PVP group and the sham injection group at 1 to 29 days and 90 days. However, compared with nonoperative therapy, PVP reduced pain at all times studied. QOL in the PVP group was improved or tended to be improved compared with QOL for both control groups. The risk of new fractures was similar between the PVP groups and both control groups.
Different control groups may have accounted for the different conclusions in the literature regarding the ability of PVP to relieve pain and restore function recovery. Compared with nonoperative treatment PVP relieved pain better and improved QOL. PVP did not increase the risk of new fractures.
Level of Evidence
Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
KeywordsVertebral Fracture Pain Relief Weighted Mean Difference Percutaneous Vertebroplasty Sham Injection
We thank all the corresponding authors from the included trials for their kind assistance in obtaining additional data that contributed to our meta-analysis.
- 1.Alfonso Olmos M, Silva Gonzalez A, Duart Clemente J, Villas Tome C. Infected vertebroplasty due to uncommon bacteria solved surgically: a rare and threatening life complication of a common procedure: report of a case and a review of the literature. Spine (Phila Pa 1976). 2006;31:E770–E773.CrossRefGoogle Scholar
- 3.Anselmetti GC, Manca A, Hirsch J, Montemurro F, Isaia G, Osella G, Chiara G, Iussich G, Debernardi F, Regge D. Percutaneous vertebroplasty in osteoporotic patients: an institutional experience of 1,634 patients with long-term follow-up. J Vasc Interv Radiol. 2011;22:1714–1720.PubMedCrossRefGoogle Scholar
- 4.Atkins D, Briss PA, Eccles M, Flottorp S, Guyatt GH, Harbour RT, Hill S, Jaeschke R, Liberati A, Magrini N, Mason J, O’Connell D, Oxman AD, Phillips B, Schünemann H, Edejer TT, Vist GE, Williams JW Jr; GRADE Working Group. Systems for grading the quality of evidence and the strength of recommendations II: pilot study of a new system. BMC Health Serv Res. 2005;5:25.PubMedCrossRefGoogle Scholar
- 7.Boluki D. [Surgical therapy of osteoporotic vertebral body fractures] [in German]. Z Rheumatol. 2011;70:45–55; quiz 55.Google Scholar
- 23.Jensen ME, McGraw JK, Cardella JF, Hirsch JA. Position statement on percutaneous vertebral augmentation: a consensus statement developed by the American Society of Interventional and Therapeutic Neuroradiology, Society of Interventional Radiology, American Association of Neurological Surgeons/Congress of Neurological Surgeons, and American Society of Spine Radiology. J Neurointerv Surg. 2009;1:181–185.PubMedCrossRefGoogle Scholar
- 26.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. A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med. 2009;361:569–579.PubMedCrossRefGoogle Scholar
- 27.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. Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial. Lancet. 2010;376:1085–1092.PubMedCrossRefGoogle Scholar
- 28.Lee BJ, Lee SR, Yoo TY. Paraplegia as a complication of percutaneous vertebroplasty with polymethylmethacrylate: a case report. Spine (Phila Pa 1976). 2002;27:E419–E422.Google Scholar
- 30.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.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. 1999;10:150–160.PubMedCrossRefGoogle Scholar
- 32.McGraw JK, Cardella J, Barr JD, Mathis JM, Sanchez O, Schwartzberg MS, Swan TL, Sacks D; Society of Interventional Radiology Standards of Practice Committee. Society of Interventional Radiology quality improvement guidelines for percutaneous vertebroplasty. (Republished from J Vasc Interv Radiol. 2003;14:827-831.) J Vasc Interv Radiol. 2003;14:S311–S315.PubMedCrossRefGoogle Scholar
- 33.McGraw JK, Cardella J, Barr JD, Mathis JM, Sanchez O, Schwartzberg MS, Swan TL, Sacks D; Society of Interventional Radiology Standards of Practice Committee. Society of Interventional Radiology quality improvement guidelines for percutaneous vertebroplasty. J Vasc Interv Radiol. 2003;14:827–831.PubMedCrossRefGoogle Scholar
- 35.Phillips FM. Minimally invasive treatments of osteoporotic vertebral compression fractures. Spine (Phila Pa 1976). 2003;28(15 suppl):S45–S53.Google Scholar
- 37.Rousing R, Andersen MO, Jespersen SM, Thomsen K, Lauritsen J. 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). 2009;34:1349–1354.Google Scholar
- 42.Tamayo-Orozco J, Arzac-Palumbo P, Peon-Vidales H, Mota-Bolfeta R, Fuentes F. Vertebral fractures associated with osteoporosis: patient management. Am J Med. 1997;103(2A):44S–50S; discussion 48S–50S.Google Scholar
- 43.Tan BHM, Hee HT. Analysis of the effects of percutaneous vertebroplasty in osteoporotic compression fractures. J Orthopaedics. 2011;8(3):e9. Available at: http://www.jortho.org/2011/8/3/e9. Accessed April 26, 2012.
- 46.Uebelhart B, Casez P, Rizzoli R, Louis-Simonet M. Prophylactic injection of methylmetacrylate in vertebrae located between two previously cemented levels does not prevent a subsequent compression fracture in a patient with bone fragility. Joint Bone Spine. 2008;75:322–324.PubMedCrossRefGoogle Scholar
- 47.Voormolen MH, Mali WP, Lohle PN, Fransen H, Lampmann LE, van der Graaf Y, Juttmann JR, Jansssens X, Verhaar HJ. 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. 2007;28:555–560.PubMedGoogle Scholar
- 48.Voormolen MH, van Rooij WJ, Sluzewski M, van der Graaf Y, Lampmann LE, Lohle PN, Juttmann JR. Pain response in the first trimester after percutaneous vertebroplasty in patients with osteoporotic vertebral compression fractures with or without bone marrow edema. AJNR Am J Neuroradiol. 2006;27:1579–1585.PubMedGoogle Scholar