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

摘要

PurposeTo 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).MethodsAs 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.ResultsPain 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.ConclusionsBKP/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...