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

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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.

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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)


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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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Correspondence to Ioannis D. Papanastassiou.

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Papanastassiou, I.D., Phillips, F.M., Van Meirhaeghe, J. et al. Comparing effects of kyphoplasty, vertebroplasty, and non-surgical management in a systematic review of randomized and non-randomized controlled studies. Eur Spine J 21, 1826–1843 (2012).

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