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Benefits of kyphoplasty vs. vertebroplasty may depend on concurrent spine problems
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In their systematic review and meta-analysis, researchers from China deemed that both kyphoplasty and vertebroplasty are safe and effective for the treatment of osteoporotic vertebral compression fractures.
Using the GRADE system, the researchers compared levels of evidence and author recommendations in 12 published studies about balloon kyphoplasty (KP) and percutaneous vertebroplasty (VP) and found significant differences for the two procedures in randomized controlled trials (RCTs).
In the RCTs they reviewed, the greatest differences between KP and VP were in short-term Visual Analog Scale (VAS) and long-term kyphotic angle results, operative times and anterior vertebral heights, the authors noted.
For the cohort studies analyzed, the researchers found that anterior vertebral heights and operative times were also significantly different between the procedures, as were the short-term and long-term VAS scores, long-term Oswestry Disability Index results, cement leakage rates, and the short-term and long-term kyphosis angles.
“KP and VP are both safe and effective surgical procedures for treating [osteoporotic vertebral compression fractures] OVCF … Due to the poor quality of the evidence currently available, high-quality RCTs are required,” the authors wrote in the abstract.
They noted the differences seen for many of these same factors in the case controlled trials, however, were not significant. A subgroup of cohort studies they included did not yield significant differences in adjacent vertebral fracture rates.
“The overall GRADE system evidence quality was very low, which lowers our confidence in their recommendations,” the authors wrote.
“KP may be superior to VP in patients with large kyphosis angles, vertebral fissures, fractures in the posterior edge of the vertebral body or significant height loss in the fractured vertebrae,” they wrote in their abstract.
Perspective
Back to TopMarc J. Nieuwenhuijse, BSc, MD
The authors should be commended on their comprehensive systematic review regarding the comparative evidence for vertebroplasty (VP) and balloon kyphoplasty (BK) for the treatment of painful osteoporotic vertebral compression fractures.
As the authors correctly point out, the strength of their recommendations is limited by the fact that only one randomized study was available and that the other included (non-randomized) comparative studies are of low study quality and/or have a high risk of bias. The randomized study found no significant or relevant differences in pain relief, functional improvement, complications and occurrence of new adjacent vertebral fractures between percutaneous VP and BK. Although BK may result in superior correction of the vertebral kyphosis angle, the clinical relevance of this generally small magnitude of the correction is unclear. In addition, although possible, additional evidence is required to support the preference of one procedure over the other in selected patient groups.
Based on the current evidence, VP and BK are comparable and beneficial treatment options for painful osteoporotic vertebral fractures. However, additional (high-quality) randomized studies which incorporate comparison of the cost-effectiveness of both procedures are required for a definitive verdict.
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Ma XL. Eur Spine J. 2012 Jul 26. [Epub ahead of print]
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