Is There Really No Benefit of Vertebroplasty for Osteoporotic Vertebral Fractures? A Meta-analysis

Overview

Journal Clin Orthop Relat Res

Publisher Wolters Kluwer

Specialty Orthopedics

Date 2012 Jun 26

PMID 22729693

Citations 29

Authors

Ming-Min Shi

Xun-Zi Cai

Tiao Lin

Wei Wang

Shi-Gui Yan

Affiliations

Soon will be listed here.

Abstract

Background: Osteoporotic vertebral compressed fractures (VCFs) are the most common osteoporotic fractures. Although percutaneous vertebroplasty (PVP) reportedly relieves pain and improves function, a recent pooled analysis from two multicenter randomized controlled trials concluded the improvement in pain and disability treated with PVP was similar to those with sham surgery.

Questions/purpose: Using meta-analysis we therefore asked whether compared with either nonoperative therapy or a sham injection for patients with VCF, PVP would (1) better relieve pain, (2) provide greater improvement in pain-related disability, and (3) increase the recurrence of vertebral fractures.

Methods: We searched PubMed, EMBASE, Medline, and the Cochrane library using the keywords "vertebroplasty AND osteoporosis OR fracture". We included nine of the 469 articles identified. Using a random effects model, we calculated the weighted mean differences to evaluate the pain reduction at different times as the primary outcome. Pain-related disability was assessed by a quality of life (QOL) measure. Improvement of QOL and recurrence of vertebral fractures were the secondary outcomes. We used subgroup analysis to reinvestigate pain relief and function improvement of PVP based on two different controls: nonoperative therapy and sham injection. The total number of patients was 886.

Results: Pain scoring was similar between the PVP group and the sham injection group at 1 to 29 days and 90 days. However, compared with nonoperative therapy, PVP reduced pain at all times studied. QOL in the PVP group was improved or tended to be improved compared with QOL for both control groups. The risk of new fractures was similar between the PVP groups and both control groups.

Conclusions: Different control groups may have accounted for the different conclusions in the literature regarding the ability of PVP to relieve pain and restore function recovery. Compared with nonoperative treatment PVP relieved pain better and improved QOL. PVP did not increase the risk of new fractures.

Level Of Evidence: Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Citing Articles

Therapeutic Efficacy and Safety of Percutaneous Curved Vertebroplasty in Osteoporotic Vertebral Compression Fractures: A Systematic Review and Meta-Analysis.

Sun Y, Zhang Y, Ma H, Tan M, Zhang Z Orthop Surg. 2023; 15(10):2492-2504.

PMID: 37497571 PMC: 10549840. DOI: 10.1111/os.13800.

Three generations of treatments for osteoporotic vertebral fractures: what is the evidence?.

Nasto L, Jannelli E, Cipolloni V, Piccone L, Cattolico A, Santagada A Orthop Rev (Pavia). 2022; 14(6):38609.

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PMID: 35925152 DOI: 10.1007/s00113-022-01188-7.

Radiological and clinical outcomes of balloon kyphoplasty for osteoporotic vertebral compression fracture in patients with rheumatoid arthritis.

Guo J, Zhai W, Wei L, Zhang J, Jin L, Yan H J Orthop Surg Res. 2021; 16(1):435.

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Vertebral Compression Fractures: Evaluation and Management.

Madassery S Semin Intervent Radiol. 2020; 37(2):214-219.

PMID: 32419735 PMC: 7224975. DOI: 10.1055/s-0040-1709208.

References

Staples M, Kallmes D, Comstock B, Jarvik J, Osborne R, Heagerty P . Effectiveness of vertebroplasty using individual patient data from two randomised placebo controlled trials: meta-analysis. BMJ. 2011; 343:d3952. PMC: 3133975. DOI: 10.1136/bmj.d3952. View

Rousing R, Andersen M, Jespersen S, Thomsen K, Lauritsen J . Percutaneous vertebroplasty compared to conservative treatment in patients with painful acute or subacute osteoporotic vertebral fractures: three-months follow-up in a clinical randomized study. Spine (Phila Pa 1976). 2009; 34(13):1349-54. DOI: 10.1097/BRS.0b013e3181a4e628. View

Alvarez L, Alcaraz M, Perez-Higueras A, Granizo J, de Miguel I, Rossi R . Percutaneous vertebroplasty: functional improvement in patients with osteoporotic compression fractures. Spine (Phila Pa 1976). 2006; 31(10):1113-8. DOI: 10.1097/01.brs.0000216487.97965.38. View

Trout A, Kallmes D . Does vertebroplasty cause incident vertebral fractures? A review of available data. AJNR Am J Neuroradiol. 2006; 27(7):1397-403. PMC: 7977557. View

Barr J, Barr M, Lemley T, McCann R . Percutaneous vertebroplasty for pain relief and spinal stabilization. Spine (Phila Pa 1976). 2000; 25(8):923-8. DOI: 10.1097/00007632-200004150-00005. View

Voormolen M, Mali W, Lohle P, Fransen H, Lampmann L, Van der Graaf Y . Percutaneous vertebroplasty compared with optimal pain medication treatment: short-term clinical outcome of patients with subacute or chronic painful osteoporotic vertebral compression fractures. The VERTOS study. AJNR Am J Neuroradiol. 2007; 28(3):555-60. PMC: 7977842. View

Huskisson E . Measurement of pain. J Rheumatol. 1982; 9(5):768-9. View

Chang C, Teng M, Wei C, Luo C, Chang F . Percutaneous vertebroplasty for patients with osteoporosis: a one-year follow-up. Acta Radiol. 2006; 47(6):568-73. DOI: 10.1080/02841850600690405. View

Lee B, Lee S . Paraplegia as a complication of percutaneous vertebroplasty with polymethylmethacrylate: a case report. Spine (Phila Pa 1976). 2002; 27(19):E419-22. DOI: 10.1097/00007632-200210010-00022. View

10.

Hiwatashi A, Moritani T, Numaguchi Y, Westesson P . Increase in vertebral body height after vertebroplasty. AJNR Am J Neuroradiol. 2003; 24(2):185-9. PMC: 7974119. View

11.

Lips P, Cooper C, Agnusdei D, Caulin F, Egger P, Johnell O . Quality of life in patients with vertebral fractures: validation of the Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO). Working Party for Quality of Life of the European Foundation for Osteoporosis. Osteoporos Int. 1999; 10(2):150-60. DOI: 10.1007/s001980050210. View

12.

Johnell O, Kanis J . An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006; 17(12):1726-33. DOI: 10.1007/s00198-006-0172-4. View

13.

Higgins J, Thompson S . Quantifying heterogeneity in a meta-analysis. Stat Med. 2002; 21(11):1539-58. DOI: 10.1002/sim.1186. View

14.

Klazen C, Lohle P, de Vries J, Jansen F, Tielbeek A, Blonk M . Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial. Lancet. 2010; 376(9746):1085-92. DOI: 10.1016/S0140-6736(10)60954-3. View

15.

McGraw J, Cardella J, Barr J, Mathis J, Sanchez O, Schwartzberg M . Society of Interventional Radiology quality improvement guidelines for percutaneous vertebroplasty. J Vasc Interv Radiol. 2003; 14(7):827-31. DOI: 10.1016/s1051-0443(07)60242-5. View

16.

Walters S, Brazier J . Comparison of the minimally important difference for two health state utility measures: EQ-5D and SF-6D. Qual Life Res. 2005; 14(6):1523-32. DOI: 10.1007/s11136-004-7713-0. View

17.

Farrokhi M, Torabinezhad S, Ghajar K . Pilot study of a new acrylic cage in a dog cervical spine fusion model. J Spinal Disord Tech. 2010; 23(4):272-7. DOI: 10.1097/BSD.0b013e3181b63da6. View

18.

Melzack R . The McGill Pain Questionnaire: major properties and scoring methods. Pain. 1975; 1(3):277-299. DOI: 10.1016/0304-3959(75)90044-5. View

19.

Bliuc D, Nguyen N, Milch V, Nguyen T, Eisman J, Center J . Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA. 2009; 301(5):513-21. DOI: 10.1001/jama.2009.50. View

20.

Ploeg W, Veldhuizen A, The B, Sietsma M . Percutaneous vertebroplasty as a treatment for osteoporotic vertebral compression fractures: a systematic review. Eur Spine J. 2006; 15(12):1749-58. DOI: 10.1007/s00586-006-0159-z. View