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Comparing effects of kyphoplasty, vertebroplasty, and non-surgical management in a systematic review of randomized and non-randomized controlled studies
Purpose 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). Methods As of February 1, 2011, a PubMed search (key words: kyphoplasty,...
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| Published in: | European spine journal 2012-09, Vol.21 (9), p.1826-1843 |
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| container_issue | 9 |
| container_start_page | 1826 |
| container_title | European spine journal |
| container_volume | 21 |
| creator | Papanastassiou, Ioannis D. Phillips, Frank M. Van Meirhaeghe, Jan Berenson, James R. Andersson, Gunnar B. J. Chung, Gary Small, Brent J. Aghayev, Kamran Vrionis, Frank D. |
| description | Purpose
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).
Methods
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.
Results
Pain reduction in both BKP (−5.07/10 points,
P
|
| doi_str_mv | 10.1007/s00586-012-2314-z |
| format | article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3459114</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1113213120</sourcerecordid><originalsourceid>FETCH-LOGICAL-c499t-ef8a8682f33ab1ef8350ea496d64c9d7951bbeddb5d0ce31d1926999cab6e7db3</originalsourceid><addsrcrecordid>eNqFks-O0zAQxi0EYkvhAbigSFw4EPDYTlJfkFDFP2klLnC2HHvS9ZLYwU6K2ifhcXHUpSpIiJM99m--8Yw_Qp4CfQWUNq8TpdWmLimwknEQ5fEeWYHgrKSSs_tkRaWgZd2AvCKPUrqlFCpJ64fkirFKcAFsRX5uwzDq6PyuwK5DM6UidMW3w3gTxl6n6fCy2GOcsI3nWHtb-ODLNMedM7ovBu31Dgf0U-F8oYt0SBMOenKmiLh3-GORjDktDO6I9ixwcWSCn2Lo-7xN02wdpsfkQaf7hE_u1jX5-v7dl-3H8vrzh0_bt9elEVJOJXYbvak3rONct5AjXlHUQta2FkbaRlbQtmhtW1lqkIMFyWoppdFtjY1t-Zq8OemOczugNbmLqHs1RjfoeFBBO_XnjXc3ahf2iotKQp72mry4E4jh-4xpUoNLBvteewxzUgDAGXBg9P8o3SzfB0Jm9Plf6G2Yo8-TWChaSSGaKlNwokwMKUXszu8GqhaLqJNFVLaIWiyijjnn2WXD54zfnsgAOwFpXHyB8bL0v1R_AWD6zFc</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1080594475</pqid></control><display><type>article</type><title>Comparing effects of kyphoplasty, vertebroplasty, and non-surgical management in a systematic review of randomized and non-randomized controlled studies</title><source>Open Access: PubMed Central</source><source>Springer Link</source><creator>Papanastassiou, Ioannis D. ; Phillips, Frank M. ; Van Meirhaeghe, Jan ; Berenson, James R. ; Andersson, Gunnar B. J. ; Chung, Gary ; Small, Brent J. ; Aghayev, Kamran ; Vrionis, Frank D.</creator><creatorcontrib>Papanastassiou, Ioannis D. ; Phillips, Frank M. ; Van Meirhaeghe, Jan ; Berenson, James R. ; Andersson, Gunnar B. J. ; Chung, Gary ; Small, Brent J. ; Aghayev, Kamran ; Vrionis, Frank D.</creatorcontrib><description>Purpose
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).
Methods
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.
Results
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.
Conclusions
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.</description><identifier>ISSN: 0940-6719</identifier><identifier>EISSN: 1432-0932</identifier><identifier>DOI: 10.1007/s00586-012-2314-z</identifier><identifier>PMID: 22543412</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer-Verlag</publisher><subject>Balloons ; Bone surgery ; Cement ; Clinical trials ; Compression ; Controlled Clinical Trials as Topic ; Extravasation ; Fractures ; Fractures, Compression - rehabilitation ; Fractures, Compression - surgery ; Humans ; Kyphoplasty ; Kyphosis ; Medicine ; Medicine & Public Health ; Neurosurgery ; Osteoporosis ; Osteoporotic Fractures - rehabilitation ; Osteoporotic Fractures - surgery ; Pain ; Pain - epidemiology ; Pain - etiology ; Quality of life ; Review ; Review Article ; Reviews ; Risk factors ; Spinal Fractures - rehabilitation ; Spinal Fractures - surgery ; Spine ; Surgical Orthopedics ; Vertebrae ; Vertebroplasty</subject><ispartof>European spine journal, 2012-09, Vol.21 (9), p.1826-1843</ispartof><rights>Springer-Verlag 2012</rights><rights>Springer-Verlag Berlin Heidelberg 2012</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c499t-ef8a8682f33ab1ef8350ea496d64c9d7951bbeddb5d0ce31d1926999cab6e7db3</citedby><cites>FETCH-LOGICAL-c499t-ef8a8682f33ab1ef8350ea496d64c9d7951bbeddb5d0ce31d1926999cab6e7db3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3459114/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3459114/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,27923,27924,53790,53792</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22543412$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Papanastassiou, Ioannis D.</creatorcontrib><creatorcontrib>Phillips, Frank M.</creatorcontrib><creatorcontrib>Van Meirhaeghe, Jan</creatorcontrib><creatorcontrib>Berenson, James R.</creatorcontrib><creatorcontrib>Andersson, Gunnar B. J.</creatorcontrib><creatorcontrib>Chung, Gary</creatorcontrib><creatorcontrib>Small, Brent J.</creatorcontrib><creatorcontrib>Aghayev, Kamran</creatorcontrib><creatorcontrib>Vrionis, Frank D.</creatorcontrib><title>Comparing effects of kyphoplasty, vertebroplasty, and non-surgical management in a systematic review of randomized and non-randomized controlled studies</title><title>European spine journal</title><addtitle>Eur Spine J</addtitle><addtitle>Eur Spine J</addtitle><description>Purpose
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).
Methods
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.
Results
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.
Conclusions
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.</description><subject>Balloons</subject><subject>Bone surgery</subject><subject>Cement</subject><subject>Clinical trials</subject><subject>Compression</subject><subject>Controlled Clinical Trials as Topic</subject><subject>Extravasation</subject><subject>Fractures</subject><subject>Fractures, Compression - rehabilitation</subject><subject>Fractures, Compression - surgery</subject><subject>Humans</subject><subject>Kyphoplasty</subject><subject>Kyphosis</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Neurosurgery</subject><subject>Osteoporosis</subject><subject>Osteoporotic Fractures - rehabilitation</subject><subject>Osteoporotic Fractures - surgery</subject><subject>Pain</subject><subject>Pain - epidemiology</subject><subject>Pain - etiology</subject><subject>Quality of life</subject><subject>Review</subject><subject>Review Article</subject><subject>Reviews</subject><subject>Risk factors</subject><subject>Spinal Fractures - rehabilitation</subject><subject>Spinal Fractures - surgery</subject><subject>Spine</subject><subject>Surgical Orthopedics</subject><subject>Vertebrae</subject><subject>Vertebroplasty</subject><issn>0940-6719</issn><issn>1432-0932</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><recordid>eNqFks-O0zAQxi0EYkvhAbigSFw4EPDYTlJfkFDFP2klLnC2HHvS9ZLYwU6K2ifhcXHUpSpIiJM99m--8Yw_Qp4CfQWUNq8TpdWmLimwknEQ5fEeWYHgrKSSs_tkRaWgZd2AvCKPUrqlFCpJ64fkirFKcAFsRX5uwzDq6PyuwK5DM6UidMW3w3gTxl6n6fCy2GOcsI3nWHtb-ODLNMedM7ovBu31Dgf0U-F8oYt0SBMOenKmiLh3-GORjDktDO6I9ixwcWSCn2Lo-7xN02wdpsfkQaf7hE_u1jX5-v7dl-3H8vrzh0_bt9elEVJOJXYbvak3rONct5AjXlHUQta2FkbaRlbQtmhtW1lqkIMFyWoppdFtjY1t-Zq8OemOczugNbmLqHs1RjfoeFBBO_XnjXc3ahf2iotKQp72mry4E4jh-4xpUoNLBvteewxzUgDAGXBg9P8o3SzfB0Jm9Plf6G2Yo8-TWChaSSGaKlNwokwMKUXszu8GqhaLqJNFVLaIWiyijjnn2WXD54zfnsgAOwFpXHyB8bL0v1R_AWD6zFc</recordid><startdate>20120901</startdate><enddate>20120901</enddate><creator>Papanastassiou, Ioannis D.</creator><creator>Phillips, Frank M.</creator><creator>Van Meirhaeghe, Jan</creator><creator>Berenson, James R.</creator><creator>Andersson, Gunnar B. J.</creator><creator>Chung, Gary</creator><creator>Small, Brent J.</creator><creator>Aghayev, Kamran</creator><creator>Vrionis, Frank D.</creator><general>Springer-Verlag</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20120901</creationdate><title>Comparing effects of kyphoplasty, vertebroplasty, and non-surgical management in a systematic review of randomized and non-randomized controlled studies</title><author>Papanastassiou, Ioannis D. ; Phillips, Frank M. ; Van Meirhaeghe, Jan ; Berenson, James R. ; Andersson, Gunnar B. J. ; Chung, Gary ; Small, Brent J. ; Aghayev, Kamran ; Vrionis, Frank D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c499t-ef8a8682f33ab1ef8350ea496d64c9d7951bbeddb5d0ce31d1926999cab6e7db3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Balloons</topic><topic>Bone surgery</topic><topic>Cement</topic><topic>Clinical trials</topic><topic>Compression</topic><topic>Controlled Clinical Trials as Topic</topic><topic>Extravasation</topic><topic>Fractures</topic><topic>Fractures, Compression - rehabilitation</topic><topic>Fractures, Compression - surgery</topic><topic>Humans</topic><topic>Kyphoplasty</topic><topic>Kyphosis</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Neurosurgery</topic><topic>Osteoporosis</topic><topic>Osteoporotic Fractures - rehabilitation</topic><topic>Osteoporotic Fractures - surgery</topic><topic>Pain</topic><topic>Pain - epidemiology</topic><topic>Pain - etiology</topic><topic>Quality of life</topic><topic>Review</topic><topic>Review Article</topic><topic>Reviews</topic><topic>Risk factors</topic><topic>Spinal Fractures - rehabilitation</topic><topic>Spinal Fractures - surgery</topic><topic>Spine</topic><topic>Surgical Orthopedics</topic><topic>Vertebrae</topic><topic>Vertebroplasty</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Papanastassiou, Ioannis D.</creatorcontrib><creatorcontrib>Phillips, Frank M.</creatorcontrib><creatorcontrib>Van Meirhaeghe, Jan</creatorcontrib><creatorcontrib>Berenson, James R.</creatorcontrib><creatorcontrib>Andersson, Gunnar B. J.</creatorcontrib><creatorcontrib>Chung, Gary</creatorcontrib><creatorcontrib>Small, Brent J.</creatorcontrib><creatorcontrib>Aghayev, Kamran</creatorcontrib><creatorcontrib>Vrionis, Frank D.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>ProQuest_Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>European spine journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Papanastassiou, Ioannis D.</au><au>Phillips, Frank M.</au><au>Van Meirhaeghe, Jan</au><au>Berenson, James R.</au><au>Andersson, Gunnar B. J.</au><au>Chung, Gary</au><au>Small, Brent J.</au><au>Aghayev, Kamran</au><au>Vrionis, Frank D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparing effects of kyphoplasty, vertebroplasty, and non-surgical management in a systematic review of randomized and non-randomized controlled studies</atitle><jtitle>European spine journal</jtitle><stitle>Eur Spine J</stitle><addtitle>Eur Spine J</addtitle><date>2012-09-01</date><risdate>2012</risdate><volume>21</volume><issue>9</issue><spage>1826</spage><epage>1843</epage><pages>1826-1843</pages><issn>0940-6719</issn><eissn>1432-0932</eissn><abstract>Purpose
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).
Methods
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.
Results
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.
Conclusions
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.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer-Verlag</pub><pmid>22543412</pmid><doi>10.1007/s00586-012-2314-z</doi><tpages>18</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0940-6719 |
| ispartof | European spine journal, 2012-09, Vol.21 (9), p.1826-1843 |
| issn | 0940-6719 1432-0932 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3459114 |
| source | Open Access: PubMed Central; Springer Link |
| subjects | Balloons Bone surgery Cement Clinical trials Compression Controlled Clinical Trials as Topic Extravasation Fractures Fractures, Compression - rehabilitation Fractures, Compression - surgery Humans Kyphoplasty Kyphosis Medicine Medicine & Public Health Neurosurgery Osteoporosis Osteoporotic Fractures - rehabilitation Osteoporotic Fractures - surgery Pain Pain - epidemiology Pain - etiology Quality of life Review Review Article Reviews Risk factors Spinal Fractures - rehabilitation Spinal Fractures - surgery Spine Surgical Orthopedics Vertebrae Vertebroplasty |
| title | Comparing effects of kyphoplasty, vertebroplasty, and non-surgical management in a systematic review of randomized and non-randomized controlled studies |
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