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Vertebral fragility fractures: clinical and radiological results of augmentation and fixation—a systematic review of randomized controlled clinical trials

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Abstract

Aim

To assess the outcome of augmentation techniques, i.e., percutaneous vertebroplasty (PVP), balloon kyphoplasty (BKP), vertebral body stenting (VBS) and fixation techniques in the management of vertebral fragility fractures (VFFs).

Methods

OVID-MEDLINE®, EMBASE, Cochrane Library, SCOPUS, Springer Link, Web of Science, Google Scholar and PubMed were searched from January 2009 to February 2019 to identify relevant studies. The methodological qualities of the studies were evaluated and relevant data were extracted.

Results

Thirteen randomized controlled trials, recruiting 1963 patients, were included. PVP, compared with conservative management (CM), showed a greater pain relief and an improved vertebral body height (VBH) restoration. Moreover, PVP revealed superior to a sham procedure for pain relief in acute VFFs. BKP, compared with CM, rapidly reduces pain and improves quality of life without increasing the risk of additional VFFs. BKP, compared with PVP, has fewer cement leakage rates and is more effective in VBH restoration. BKP should also be preferred to VBS, since it is associated with less material-related complications. Pedicle screw fixation associated with PVP, compared with PVP alone, revealed effective in preventing secondary VFFs.

Conclusions

BKP showed better clinical and radiological outcomes compared with CM and PVP. BKP revealed as effective as VBS in VBH restoration with less material-related complications.

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The authors declare that they have received no funding for the study

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Authors and Affiliations

  1. Orthopaedic and Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari “Aldo Moro”, AOU Consorziale “Policlinico”, Piazza Giulio Cesare 11, 70124, Bari, Italy

    Andrea Piazzolla, Davide Bizzoca, Giuseppe Solarino, Lorenzo Moretti & Biagio Moretti

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  1. Andrea Piazzolla
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  2. Davide Bizzoca
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  3. Giuseppe Solarino
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  4. Lorenzo Moretti
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  5. Biagio Moretti
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Correspondence to Biagio Moretti.

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Piazzolla, A., Bizzoca, D., Solarino, G. et al. Vertebral fragility fractures: clinical and radiological results of augmentation and fixation—a systematic review of randomized controlled clinical trials. Aging Clin Exp Res 32, 1219–1232 (2020). https://doi.org/10.1007/s40520-019-01289-1

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