-
Annals of Palliative Medicine Nov 2021Percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) are common vertebral augmentation (VA) procedures for the treatment of osteoporotic vertebral... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) are common vertebral augmentation (VA) procedures for the treatment of osteoporotic vertebral compression fractures (OVCF), each with their own advantages and disadvantages. In recent years, the development of new implant-assisted technologies has provided a breakthrough in VA. This study systematically evaluated and meta-analyzed the reports on new implant-assisted VA techniques in recent years, so as to provide evidence for clinical diagnosis and treatment.
METHODS
The PubMed, Embase, Ovid, and SpringerLink databases were searched for randomized controlled studies on VA in the treatment of OVCF. In this study, patients in the experimental group were treated with PVP using the new implant-assisted VA technique, while patients in the control group were treated with PKP. Bias assessment was conducted using the tool integrated with the Revman 5.4 software, and meta-analysis was carried out to compare the mid-term postoperative pain relief, functional status, quality of life, and cement extravasation between the two groups (each presented with a forest plot).
RESULTS
Eight articles were finally included in the selection, involving a total of 1,027 patients. PVP surgery using the new implant-assisted VA technique was superior to PKP surgery in relieving postoperative pain [mean difference (MD) =-3.77, 95% CI: -5.63, -1.92, P<0.0001] and improving the postoperative Oswestry Disability Index (ODI) score (MD =-1.59, 95% CI: -3.01, -0.16, P=0.03). However, it was not significantly different from PKP surgery in improving postoperative quality of life (MD =-0.27, 95% CI: -3.55, 3.01, P=0.87), and the cement extravasation rate was significantly lower than that of PKP surgery [odd ratio (OR) =0.38, 95% CI: 0.19, 0.74, P=0.004].
DISCUSSION
The new implant-assisted VA technique can significantly relieve pain, reduce clinical symptoms, improve postoperative quality of life, and significantly reduce the problem of cement extravasation. However, this new technology is still evolving, and more high-quality randomized controlled studies on this topic are needed to provide stronger evidence.
Topics: Fractures, Compression; Humans; Pain, Postoperative; Quality of Life; Spinal Fractures; Vertebroplasty
PubMed: 34872301
DOI: 10.21037/apm-21-2834 -
Journal of Orthopaedic Surgery and... Oct 2021Osteoporotic vertebral compression fracture (OVCF) is one of the most common fragile fractures, and percutaneous vertebroplasty provides considerable long-term benefits.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Osteoporotic vertebral compression fracture (OVCF) is one of the most common fragile fractures, and percutaneous vertebroplasty provides considerable long-term benefits. At the same time, there are many reports of postoperative complications, among which fracture after percutaneous vertebroplasty is one of the complications after vertebroplasty (PVP). Although there are many reports on the risk factors of secondary fracture after PVP at home and abroad, there is no systematic analysis on the related factors of secondary fracture after PVP.
METHODS
The databases, such as CNKI, Wan Fang Database and PubMed, were searched for documents on secondary fractures after percutaneous vertebroplasty published at home and abroad from January 2011 to March 2021. After strictly evaluating the quality of the included studies and extracting data, a meta-analysis was conducted by using Revman 5.3 software.
RESULTS
A total of 9 articles were included, involving a total of 1882 patients, 340 of them diagnosed as secondary fractures after percutaneous vertebroplasty.
CONCLUSION
The additional history of fracture, age, bone mineral density (BMD), bone cement leakage, intravertebral fracture clefts and Cobb Angle might be risk factors related to secondary fractures after percutaneous vertebroplasty for osteoporotic vertebral compression fractures. The height of vertebral anterior and body mass index (BMI) were not correlated.
Topics: Bone Cements; Fractures, Compression; Humans; Osteoporotic Fractures; Retrospective Studies; Risk Factors; Spinal Fractures; Treatment Outcome; Vertebroplasty
PubMed: 34717682
DOI: 10.1186/s13018-021-02722-w -
JBJS Reviews Oct 2021Osteoporotic vertebral fractures (OVFs) have become increasingly common, and previous nonrandomized and randomized controlled trials (RCTs) have compared the effects of... (Meta-Analysis)
Meta-Analysis
Systematic Review and Meta-Analysis of 3 Treatment Arms for Vertebral Compression Fractures: A Comparison of Improvement in Pain, Adjacent-Level Fractures, and Quality of Life Between Vertebroplasty, Kyphoplasty, and Nonoperative Management.
BACKGROUND
Osteoporotic vertebral fractures (OVFs) have become increasingly common, and previous nonrandomized and randomized controlled trials (RCTs) have compared the effects of cement augmentation versus nonoperative management on the clinical outcome. This meta-analysis focuses on RCTs and the calculated differences between cement augmentation techniques and nonsurgical management in outcome (e.g., pain reduction, adjacent-level fractures, and quality of life [QOL]).
METHODS
A systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, and the following scientific search engines were used: MEDLINE, Embase, Cochrane, Web of Science, and Scopus. The inclusion criteria included RCTs that addressed different treatment strategies for OVF. The primary outcome was pain, which was determined by a visual analog scale (VAS) score; the secondary outcomes were the risk of adjacent-level fractures and QOL (as determined by the EuroQol-5 Dimension [EQ-5D] questionnaire, the Oswestry Disability Index [ODI], the Quality of Life Questionnaire of the European Foundation for Osteoporosis [QUALEFFO], and the Roland-Morris Disability Questionnaire [RDQ]). Patients were assigned to 3 groups according to their treatment: vertebroplasty (VP), kyphoplasty (KP), and nonoperative management (NOM). The short-term (weeks), midterm (months), and long-term (>1 year) effects were compared. A random effects model was used to summarize the treatment effect, including I2 for assessing heterogeneity and the revised Cochrane risk-of-bias 2 (RoB 2) tool for assessment of ROB. Funnel plots were used to assess risk of publication bias. The log of the odds ratio (OR) between treatments is reported.
RESULTS
After screening of 1,861 references, 53 underwent full-text analysis and 16 trials (30.2%) were included. Eleven trials (68.8%) compared VP and NOM, 1 (6.3%) compared KP and NOM, and 4 (25.0%) compared KP and VP. Improvement of pain was better by 1.31 points (95% confidence interval [CI], 0.41 to 2.21; p < 0.001) after VP when compared with NOM in short-term follow-up. Pain effects were similar after VP and KP (midterm difference of 0.0 points; 95% CI, -0.25 to 0.25). The risk of adjacent-level fractures was not increased after any treatment (log OR, -0.16; 95% CI, -0.83 to 0.5; NOM vs. VP or KP). QOL did not differ significantly between the VP or KP and NOM groups except in the short term when measured by the RDQ.
CONCLUSIONS
This meta-analysis provides evidence in favor of the surgical treatment of OVFs. Surgery was associated with greater improvement of pain and was unrelated to the development of adjacent-level fractures or QOL. Although improvements in sagittal balance after surgery were poorly documented, surgical treatment may be warranted if pain is a relevant problem.
LEVEL OF EVIDENCE
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Topics: Fractures, Compression; Humans; Kyphoplasty; Pain; Quality of Life; Vertebroplasty
PubMed: 34695056
DOI: 10.2106/JBJS.RVW.21.00045 -
World Neurosurgery Jan 2022This study was designed to help elucidate the benefits and advantages of vertebroplasty combined with zoledronic acid (ZOL) versus vertebroplasty alone, to provide... (Meta-Analysis)
Meta-Analysis
Percutaneous Vertebroplasty Combined with Zoledronic Acid in Treatment and Prevention of Osteoporotic Vertebral Compression Fractures: A Systematic Review and Meta-Analysis of Comparative Studies.
OBJECTIVE
This study was designed to help elucidate the benefits and advantages of vertebroplasty combined with zoledronic acid (ZOL) versus vertebroplasty alone, to provide clinical recommendations for the treatment of osteoporotic vertebral compression fractures (OVCFs) considering the current best-available evidence.
METHODS
We comprehensively searched PubMed, Embase, Web of Science, and the Cochrane Library and performed a systematic review and cumulative meta-analysis of all randomized controlled trials and retrospective comparative studies assessing these important indexes of 2 methods using Review Manager 5.4.
RESULTS
Four randomized controlled trials and 4 retrospective studies including 2335 cases were identified. Vertebroplasty combined with ZOL was associated with benefits from decreased pain (weighted mean difference [WMD] -0.43; 95% confidence interval [CI] -0.59 to -0.27; P < 0.05), increased function (WMD -4.94; 95% CI -6.13 to -3.75; P < 0.05), increased BMD of the vertebral body(WMD 0.85; 95% CI 0.30-1.40; P < 0.05) and of the proximal femoral neck (WMD 0.14; 95% CI 0.08-0.21; P < 0.05), fewer markers of bone metabolism (N-terminal molecular fragment: WMD -4.82; 95% CI -6.08 to -3.55; P < 0.05; procollagen type I N-terminal propeptide: WMD -17.31; 95% CI -18.04 to -16.58; P < 0.05; beta collagen degradation product: WMD -0.27; 95% CI -0.35 to -0.19; P < 0.05), and lower rate of refracture (1.54% and 12.6%; odds ratio 0.17; 95% CI 0.08-0.36; P < 0.05). Patients in the vertebroplasty combined with ZOL group had greater vertebral body height (WMD 2.17; 95% CI 0.72-3.62; P < 0.05) than in the vertebroplasty group, but no differences on Cobb angle were observed (WMD -1.18; 95% CI -2.47 to 0.10; P > 0.05).
CONCLUSIONS
Vertebroplasty combined with ZOL was superior to vertebroplasty alone in terms of BMD, bone metabolism makers, refracture rate, pain and function.
Topics: Aged; Bone Density Conservation Agents; Combined Modality Therapy; Female; Fractures, Compression; Humans; Male; Middle Aged; Osteoporotic Fractures; Randomized Controlled Trials as Topic; Spinal Fractures; Vertebroplasty; Zoledronic Acid
PubMed: 34655820
DOI: 10.1016/j.wneu.2021.09.131 -
Neurosurgical Review Apr 2022Osteoporotic vertebral compression fractures of the thoracolumbar spine can progress to Kümmell's disease, an avascular vertebral osteonecrosis. Vertebral augmentation... (Meta-Analysis)
Meta-Analysis Review
Osteoporotic vertebral compression fractures of the thoracolumbar spine can progress to Kümmell's disease, an avascular vertebral osteonecrosis. Vertebral augmentation (VA)-vertebroplasty and/or kyphoplasty-is the main treatment modality, but additional short-segment fixation (SSF) has been recommended concomitant to VA. The aim is to compare clinical and radiological outcomes of VA + SSF versus VA alone. Systematic review, including comparative articles in Kümmell's disease, was performed. This study assessed the following outcome measurements: visual analog scale (VAS), Oswestry Disability Index (ODI), anterior vertebral height (AVH), local kyphotic angle (LKA), operative time, blood loss, length of stay, and cement leakage. Six retrospective studies were included, with 126 patients in the VA + SSF group and 152 in VA alone. Pooled analysis showed the following: VAS, non-significant difference favoring VA + SSF: MD -0.61, 95% CI (-1.44, 0.23), I 91%, p = 0.15; ODI, non-significant difference favoring VA + SSF: MD -9.85, 95% CI (-19.63, -0.07), I 96%, p = 0.05; AVH, VA + SSF had a non-significant difference over VA alone: MD -3.21 mm, 95% CI (-7.55, 1.14), I 92%, p = 0.15; LKA, non-significant difference favoring VA + SSF: MD -0.85°, 95% CI (-5.10, 3.40), I 95%, p = 0.70. There were higher operative time, blood loss, and hospital length of stay for VA + SSF (p < 0.05), but with lower cement leakage (p < 0.05). VA + SFF and VA alone are effective treatment modalities in Kümmell's disease. VA + SSF may provide superior long-term results in clinical and radiological outcomes but required a longer length of stay.
Topics: Bone Cements; Fractures, Compression; Humans; Kyphoplasty; Osteoporotic Fractures; Retrospective Studies; Spinal Fractures; Treatment Outcome; Vertebroplasty
PubMed: 34596773
DOI: 10.1007/s10143-021-01661-8 -
Pain Physician Sep 2021The management of pain after osteoporotic thoracolumbar burst fracture has not reached a treatment consensus. Percutaneous kyphoplasty has been shown to be efficient in...
BACKGROUND
The management of pain after osteoporotic thoracolumbar burst fracture has not reached a treatment consensus. Percutaneous kyphoplasty has been shown to be efficient in reducing acute pain after burst fracture, although the topic remains highly controversial in this field.
OBJECTIVE
This study aimed to conduct a systematic review of the current literature to evaluate the effectiveness and safety of percutaneous kyphoplasty on the treatment of osteoporotic thoracolumbar burst fracture.
STUDY DESIGN
A systematic review.
SETTING
University hospital.
METHODS
A comprehensive literature search was performed through PubMed, EMBASE, Web of Science, and Cochrane library without time restriction. Among the studies meeting the eligible criteria, any study in which percutaneous kyphoplasty was utilized alone in the treatment of osteoporotic thoracolumbar burst fracture was included in the current review. For radiographic outcome evaluation, vertebral height and kyphotic angle were analyzed. VAS (Visual Analog Scale) and ODI (Oswestry Disability Index) were utilized for clinical outcome evaluation. Complications such as cement leakage and adjacent vertebral fracture or relapse were also analyzed.
RESULTS
In total, 289 patients (338 vertebral bodies) were included in the 8 studies. Clinical outcomes indicated that patients achieved pain relief (VAS) from 6.8 preoperatively to 1.1 postoperatively, and improvement of quality of life (ODI) ranged from 87.0 ± 6.0% to 23.9 ± 4.4%. The radiological outcome indicated that anterior vertebral height restoration ranged from 20.1 ± 2.3 to 85.3 ± 10.6, and posterior vertebral height restoration ranged from 27.3 ± 1.7 to 83.3 ± 7.4. Kyphotic angle achieved correction ranged from 21.7 ± 7.8° preoperatively to 3.17° postoperatively. The main complications after PKP were cement leakage and adjacent vertebral fracture or relapse, which had an incidence of 7.7% -45.4% and 4.3% -74.1%, respectively.
LIMITATIONS
Due to the good quality of the English publications, only English-language research searches were conducted, but they do not unduly affect our aggregate results impact. More prospective randomized controlled trials are needed to provide higher evidence for clinical practice.
CONCLUSIONS
To osteoporotic thoracolumbar burst fracture is absolutely not a contraindication to percutaneous kyphoplasty. Percutaneous kyphoplasty can obtain satisfactory effectiveness for the treatment of osteoporotic thoracolumbar burst fractures. Complications can be effectively decreased by meticulous evaluation, careful manipulation, and appropriate precautionary measures.
Topics: Bone Cements; Contraindications; Fractures, Compression; Humans; Kyphoplasty; Osteoporotic Fractures; Prospective Studies; Quality of Life; Retrospective Studies; Spinal Fractures; Treatment Outcome
PubMed: 34554685
DOI: No ID Found -
European Review For Medical and... Aug 2021This study aimed to investigate whether percutaneous vertebral augmentation (PVA) was associated with clinical and radiological subsequent adjacent fractures in patients... (Meta-Analysis)
Meta-Analysis
Percutaneous vertebral augmentation for osteoporotic vertebral compression fractures will increase the number of subsequent fractures at adjacent vertebral levels: a systematic review and meta-analysis.
OBJECTIVE
This study aimed to investigate whether percutaneous vertebral augmentation (PVA) was associated with clinical and radiological subsequent adjacent fractures in patients with osteoporotic vertebral compression fractures.
MATERIALS AND METHODS
The systematic review was performed following PRISMA guidelines. Data were retrieved from PubMed, EMBASE, Cochrane Library, Google Scholar, Web of Science, and ClinicalTrial.gov, from database inception to March 2020. Eligible studies were those that assessed subsequent adjacent fractures after PVA in comparison with conservative treatment (CT). The number of patients with adjacent secondary vertebral fractures was calculated, and the pooled risk ratio (RR) with its 95% confidence intervals (95% CI) was used. Moreover, heterogeneity, sensitivity, and publication bias analyses were performed.
RESULTS
Twenty-four studies were included finally. Moreover, 20/421 (4.75%) patients from the PVA group and 25/359 (6.96%) patients from the CT group had clinical subsequent adjacent fractures, and 46/440 (10.45%) patients from the PVA group and 36/444 (8.10%) patients from the CT group had radiological subsequent adjacent fractures. Both had no significant difference between the two groups (RR = 0.67, 95% CI [0.38, 1.19], p = 0.17)/(RR = 1.13, 95% CI [0.75, 1.70], p = 0.576). However, the number of fractured vertebrae was higher in the PVA group than in the CT group (RR = 1.41, 95% CI [1.03, 1.93], p = 0.03). A sensitivity analysis did not identify specific trials that seriously deflected. No obvious publication bias was identified.
CONCLUSIONS
The systematic review revealed that PVA did not increase the incidence for subsequent adjacent fractures regardless of whether they were clinical or radiological fractures. However, PVA can increase the number of subsequent fractures at adjacent vertebral levels.
Topics: Fractures, Compression; Humans; Incidence; Osteoporotic Fractures; Radiography; Spinal Fractures; Vertebroplasty
PubMed: 34486692
DOI: 10.26355/eurrev_202108_26531 -
Global Spine Journal Jul 2022Systematic review.
Instrumentation Techniques to Prevent Proximal Junctional Kyphosis and Proximal Junctional Failure in Adult Spinal Deformity Correction: A Systematic Review of Clinical Studies.
STUDY DESIGN
Systematic review.
OBJECTIVES
To summarize the results of clinical studies investigating spinal instrumentation techniques aiming to reduce the postoperative incidence of proximal junctional kyphosis (PJK) and/or failure (PJF) in adult spinal deformity (ASD) patients.
METHODS
EMBASE and Medline® were searched for articles dating from January 2000 onward. Data was extracted by 2 independent authors and methodological quality was assessed using ROBINS-I.
RESULTS
18 retrospective- and prospective cohort studies with a severe or critical risk of bias were included. Different techniques were applied at the upper instrumented vertebra (UIV): tethers in various configurations, 2-level prophylactic vertebroplasty (2-PVP), transverse process hooks (TPH), flexible rods (FR), sublaminar tapes (ST) and multilevel stabilization screws (MLSS). Compared to a pedicle screw (PS) group, significant differences in PJK incidence were found using tethers in various configurations (18% versus 45%, = 0.001, 15% versus 38%, = 0.045), 2-PVP (24% vs 36%, = 0.020), TPH (0% vs. 30%, = 0.023) and FR (15% versus 38%, = 0.045). Differences in revision rates for PJK were found in studies concerning tethers (4% versus 18%, = 0.002), 2-PVP (0% vs 13%, = 0.031) and TPH (0% vs 7%, = n.a.).
CONCLUSION
Although the studies are of low quality, the most frequently studied techniques, namely 2-PVP as anterior reinforcement and (tensioned) tethers or TPH as posterior semi-rigid fixation, show promising results. To provide a reliable comparison, more controlled studies need to be performed, including the use of clinical outcome measures and a uniform definition of PJF.
PubMed: 34325554
DOI: 10.1177/21925682211034500 -
BMC Musculoskeletal Disorders Jun 2021The economic burden of vertebral compression fractures (VCF) caused by osteoporosis was estimated at 37 billion euros in the European Union in 2010. In addition, the...
BACKGROUND
The economic burden of vertebral compression fractures (VCF) caused by osteoporosis was estimated at 37 billion euros in the European Union in 2010. In addition, the incidence is expected to increase by 25% in 2025. The recommendations for the therapy of VCFs (conservative treatment versus cement augmentation procedures) are controversial, what could be partly explained by the lack of standardized outcomes for measuring the success of both treatments. Consensus on outcome parameters may improve the relevance of a study and for further comparisons in meta-analyses. The aim of this study was to analyze outcome measures from frequently cited randomized controlled trials (RCTs) about VCF treatments in order to provide guidance for future studies.
MATERIAL AND METHODS
We carried out a systematic search of all implemented databases from 1973 to 2019 using the Web of Science database. The terms "spine" and "random" were used for the search. We included: Level I RCTs, conservative treatment or cement augmentation of osteoporotic vertebral fractures, cited ≥50 times. The outcome parameters of each study were extracted and sorted according to the frequency of use.
RESULTS
Nine studies met the inclusion criteria. In total, 23 different outcome parameters were used in the nine analyzed studies. Overall, the five most frequently used outcome parameters (≥ 4 times used) were the visual analogue scale (VAS) for pain (n = 9), European Quality of Life-5 Dimensions (EQ-5D; n = 4) and Roland-Morris Disability Questionnaire (RMDQ, n = 4).
CONCLUSION
With our study, we demonstrated that a large inconsistency exists between outcome measures in highly cited Level I studies of VCF treatment. Pain (VAS), followed by HrQoL (EQ-5D) and disability and function (RMDQ), opioid use, and radiological outcome (kyphotic angle, VBH, and new VCFs) were the most commonly used outcome parameters.
Topics: Fractures, Compression; Humans; Kyphoplasty; Osteoporotic Fractures; Randomized Controlled Trials as Topic; Spinal Fractures; Treatment Outcome; Vertebroplasty
PubMed: 34167510
DOI: 10.1186/s12891-021-04305-6