Skip to main content

Table 3 Summary of the interventions and recommendations

From: Percutaneous vertebroplasty as treatment of malignant vertebral lesions: a systematic review and GRADE evaluation resulting in a Danish national clinical guideline

PICO 1. Should patients with painful vertebral lesions and malignant disease be offered percutaneous vertebroplasty or kyphoplasty as compared to non-operative treatment?
↑ Consider offering percutaneous vertebroplasty/kyphoplasty to patients with painful vertebral lesions and malignant disease (⊕ OOO) Definition: Cemental augmentation in patients with painful vertebral lesions and non-hematological malignant disease
Included studies: One RCT [6] and no useful meta-analyses
Primary outcomes: Clinically relevant effect in favor of KP on the primary outcome VAS at 1-month follow-up. Clinically relevant effect in favor of KP on the secondary outcomes Karnofsky performance status (KPS) at 1-month follow-up, Roland–Morris disability index (RDQ) at 1-month follow-up, and Short Form 36 (SF-36) at 1-month follow-up. We found no increased risk of side effects or serious adverse events
Comment: The quality of the evidence was overall low due to the lack of randomized controlled trials and two domains with high risk of bias in the quality assessment of the included RCT
PICO 2. Should patients with painful vertebral lesions and malignant hematologic disease be offered percutaneous vertebroplasty or kyphoplasty as compared to non-operative treatment?
↑ Consider offering percutaneous vertebroplasty/kyphoplasty to patients with painful vertebral lesions and hematologic malignant disease (⊕ OOO) Definition: Cemental augmentation in patients with painful vertebral lesions and hematological malignant disease
Included studies: Two RCTs [6, 7] and no useful meta-analyses
Primary outcomes: Clinically relevant effect in favor of vertebral augmentation on the primary outcome VAS at 1-month follow-up. Clinically relevant effect in favor of vertebral augmentation on the secondary outcomes KPS at 1-month follow-up, RDQ at 1-month follow-up, Oswestry Disability Index (ODI) at 6-month follow-up, and SF-36 at 1-month follow-up
Comment: The quality of the evidence was moderate. The quality was downgraded due to “imprecision” because one of the two studies includes patients with both hematologic and non-hematologic malignant diseases. Furthermore, both studies contained two domains with high risk of bias in the quality assessment
PICO 3. Should patients with painful vertebral lesions, fracture of the posterior wall, and malignant disease be offered percutaneous vertebroplasty or kyphoplasty?
√It is good practice to offer percutaneous vertebroplasty or kyphoplasty to patients with painful vertebral lesions, fracture of the posterior wall, and malignant disease as there is no literature describing increased risk of complications in these patients Definition: Cemental augmentation in patients with malignant disease, painful vertebral lesions, and fracture of the posterior wall of the vertebral body
Included studies: No RCTs were identified. Two cohort studies and five studies of purely descriptive character were identified [8,9,10,11,12,13]
Comment: Since we identified no relevant RCTs or meta-analyses on the subject, the final recommendation is based on the experiences of the working group and the identified observational studies