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Global Spine Journal Jun 2024Systematic review and meta-analysis. (Review)
Review
Mechanical Vertebral Body Augmentation Versus Conventional Balloon Kyphoplasty for Osteoporotic Thoracolumbar Compression Fractures: A Systematic Review and Meta-Analysis of Outcomes.
STUDY DESIGN
Systematic review and meta-analysis.
OBJECTIVE
Surgical management of osteoporotic vertebral compression fractures (OVCFs) has traditionally consisted of vertebroplasty or kyphoplasty procedures. Mechanical percutaneous vertebral body augmentation (MPVA) systems have recently been introduced as alternatives to traditional methods. However, the effectiveness of MPVA systems vs conventional augmentation techniques for OVCFs remains unclear. This serves as the premise for this study.
METHODS
A systematic review and meta-analysis was conducted as per the guidelines. Studies of interest included randomized controlled trials (RCTs) which directly compared patient outcomes following kyphoplasty to patients treated with MPVA systems. Clinical and radiological findings were collated and compared for significance between cohorts.
RESULTS
6 RCTs were identified with 1024 patients total. The mean age of all patients was 73.5 years. 17% of the cohort were male, 83% were female. 515 patients underwent kyphoplasty and 509 underwent mechanical vertebral body augmentation using MPVA systems. MPVAs showed similar efficacy for restoration of vertebral body height ( = .18), total complications ( = .36), cement extravasation ( = .58) and device-related complications ( = .06). MPVAs also showed reduced rates of all new fractures (16.4% vs 22.2%; = .17) and adjacent fractures (14.7% vs 18.9%; = .23), with improved visual analogue scale (VAS) scores at 6-month ( = .13).
CONCLUSION
The results of this meta-analysis highlight no significant improvement in clinical or radiological outcomes for MPVA systems when compared to balloon kyphoplasty for vertebral body augmentation. Further research is needed to establish a true benefit over traditional operative methods.
PubMed: 38889443
DOI: 10.1177/21925682241261988 -
Neurospine Dec 2023We aimed to comprehensively compare surgical methods for osteoporotic vertebral compression fracture (OVCF) using systematic review and network meta-analysis to...
OBJECTIVE
We aimed to comprehensively compare surgical methods for osteoporotic vertebral compression fracture (OVCF) using systematic review and network meta-analysis to understand their effectiveness and outcomes, as current research provides limited overviews.
METHODS
We followed PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines, preregistering our protocol with PROSPERO. We analyzed Englishpublished randomized controlled trials (RCTs) on adults with OVCFs that evaluated pain intensity or functionality using tools like visual analogue scale (VAS) or Oswestry Disability Index (ODI). Exclusions included non-RCTs, malignancy-related fractures, and certain interventions. Using the RoB 2 tool, we assessed bias and visualized results with Robvis. Our primary outcome was pain intensity, with secondary outcomes including disability, new fractures, and cement leakage. Results were synthesized using Stata/MP.
RESULTS
Thirty-four RCTs from 10 countries, totaling 4,384 patients, were analyzed. Shortterm VAS indicated kyphoplasty with facet joint injection (KIJ) as the top treatment at 87.7%, while unipedicular kyphoplasty (UKP) led to long-term at 74.9%. Short-term ODI favored vertebroplasty with facet joint injection (VIJ) at 98.4%, with kyphoplasty (KP) leading longterm at 66.0%. All surgical techniques were superior to conservative treatment. Vertebral augmentation devices reported the fewest new fractures and curved vertebroplasty had the least cement leakage. SUCRA (surface under the cumulative ranking) analyses suggested UKP and VIJ as top choices for postoperative pain relief, with VIJ excelling in postoperative disability improvement.
CONCLUSION
Our analysis evaluates 12 OVCF interventions, underscoring KIJ for short-term pain relief and VIJ and UKP for long-term efficacy. Notably, VIJ stands out in disability outcomes, emphasizing the need for comprehensive OVCF management.
PubMed: 38171285
DOI: 10.14245/ns.2346996.498 -
Journal of Orthopaedic Surgery and... Oct 2018This meta-analysis was aimed to explore the overall safety and efficacy of balloon kyphoplasty versus percutaneous vertebroplasty for osteoporotic vertebral compression... (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
This meta-analysis was aimed to explore the overall safety and efficacy of balloon kyphoplasty versus percutaneous vertebroplasty for osteoporotic vertebral compression fracture (OVCF) based on qualified studies.
METHODS
By searching multiple databases and sources, including PubMed, Cochrane, and Embase by the index words updated to January 2018, qualified studies were identified and relevant literature sources were also searched. The qualified studies included randomized controlled trials, prospective or retrospective comparative studies, and cohort studies. The meta-analysis was performed including mean difference (MD) or relative risk (RR) and 95% confidence interval (95% CI) to analyze the main outcomes.
RESULTS
A total of 16 studies were included in the meta-analysis to explore the safety and efficacy of kyphoplasty versus vertebroplasty for the treatment of OVCF. The results indicated that kyphoplasty significantly decreased the kyphotic wedge angle (SMD, 0.98; 95% CI 0.40-1.57), increased the postoperative vertebral body height (SMD, - 1.27; 95% CI - 1.86 to - 0.67), and decreased the risk of cement leakage (RR, 0.62; 95% CI 0.47-0.80) in comparison with vertebroplasty. However, there was no statistical difference in visual analog scale (VAS) scores (WMD, 0.04; 95% CI - 0.28-0.36) and Oswestry Disability Index (ODI) scores (WMD, - 1.30; 95% CI - 3.34-0.74) between the two groups.
CONCLUSIONS
Kyphoplasty contributes especially to decreasing the mean difference of kyphotic wedge angle and risk of cement leakage and increasing the vertebral body height when compared with vertebroplasty. But radiographic differences did not significantly influence the clinical results (no significant difference was observed in VAS scores and ODI scores between the two groups); thus, kyphoplasty and vertebroplasty are equally effective in the clinical outcomes of OVCF. In addition, more high-quality multi-center RCTs with a larger sample size and longer follow-up are warranted to confirm the current findings.
Topics: Bone Cements; Extravasation of Diagnostic and Therapeutic Materials; Fractures, Compression; Humans; Kyphoplasty; Osteoporotic Fractures; Postoperative Complications; Spinal Fractures; Vertebroplasty
PubMed: 30348192
DOI: 10.1186/s13018-018-0952-5 -
European Spine Journal : Official... Sep 2009Balloon kyphoplasty and percutaneous vertebroplasty are relatively recent procedures in the treatment of painful vertebral fractures. There are, however, still some... (Review)
Review
Balloon kyphoplasty and percutaneous vertebroplasty are relatively recent procedures in the treatment of painful vertebral fractures. There are, however, still some uncertainties about the incidence and treatment strategies of pulmonary cement embolisms (PCE). In order to work out a treatment strategy for the management of this complication, we performed a review of the literature. The results show that there is no clear diagnostic or treatment standard for PCE. The literature research revealed that the risk of a pulmonary embolism ranges from 3.5 to 23% for osteoporotic fractures. In cases of asymptomatic patients with peripheral PCE we recommend no treatment besides clinical follow-up; in cases of symptomatic or central embolisms, however, we recommend to proceed according to the guidelines regarding the treatment of thrombotic pulmonary embolisms, which includes initial heparinization and a following 6-month coumarin therapy. In order to avoid any types of embolisms, both procedures should only be performed by experienced surgeons after critical determination of the indications.
Topics: Anticoagulants; Bone Cements; Humans; Osteoporosis; Patient Selection; Postoperative Complications; Pulmonary Embolism; Spinal Curvatures; Spinal Fractures; Vertebroplasty
PubMed: 19575243
DOI: 10.1007/s00586-009-1073-y -
Global Spine Journal May 2023Systematic review. (Review)
Review
STUDY DESIGN
Systematic review.
OBJECTIVES
Vertebral haemangioma has been classified into typical and aggressive vertebral haemangioma (AVH). Management options for AVH are many and the clinician has decision dilemma in choosing the right one. Metastases mimic AVH in clinical and radiological presentation. Differentiating pointers between them has not been clearly delineated in literature. Aim of our review is to identify treatment options; to formulate a management algorithm for AVH based on clinical presentation and to identify radiological differentiating pointers between them.
METHODS
Systematic review was conducted according to PRISMA guidelines. We systematically reviewed all available literature from the year 2001 to 2020. Relevant articles were identified as per laid down criteria from the medical databases. After inclusion, first and second authors went through full text of each included article.
RESULTS
Of 139 studies reviewed, eight met our criteria for review of management and three separate studies for radiological differentiating pointers. 99 patients with 88 AVH had undergone treatment. Back pain with myelopathy is the presenting symptom in majority of patients. Patients with backpain - myelopathic symptoms had improved following surgery; patients with back pain alone had improved with either percutaneous vertebroplasty or CT guided alcohol ablation. Dynamic contrast MRI, Diffusion weighted MRI and ratio of signal intensity between T1w and fat suppression T1w MR help the clinician in differentiating them.
CONCLUSION
Management of AVH can be based on the patient's clinical presentation. Patients presenting with AVH and back pain can be managed with either Percutaneous vertebroplasty or CT guided alcohol ablation. Patients presenting with AVH and neurological symptoms could be managed with surgery. Dynamic contrast enhanced MR, Diffusion weighted MR, ratio of signal intensity between T1w and Fat suppression T1w MR imaging could help the clinician in differentiating the two before contemplating biopsy.
GRADE PRACTICE RECOMMENDATION
C.
PubMed: 36317457
DOI: 10.1177/21925682221137026 -
Ontario Health Technology Assessment... 2016Cancers that metastasize to the spine and primary cancers such as multiple myeloma can result in vertebral compression fractures or instability. Conservative strategies,... (Review)
Review
BACKGROUND
Cancers that metastasize to the spine and primary cancers such as multiple myeloma can result in vertebral compression fractures or instability. Conservative strategies, including bed rest, bracing, and analgesic use, can be ineffective, resulting in continued pain and progressive functional disability limiting mobility and self-care. Surgery is not usually an option for cancer patients in advanced disease states because of their poor medical health or functional status and limited life expectancy. The objectives of this review were to evaluate the effectiveness and safety of percutaneous image-guided vertebral augmentation techniques, vertebroplasty and kyphoplasty, for palliation of cancer-related vertebral compression fractures.
METHODS
We performed a systematic literature search for studies on vertebral augmentation of cancer-related vertebral compression fractures published from January 1, 2000, to October 2014; abstracts were screened by a single reviewer. For those studies meeting the eligibility criteria, full-text articles were obtained. Owing to the heterogeneity of the clinical reports, we performed a narrative synthesis based on an analytical framework constructed for the type of cancer-related vertebral fractures and the diversity of the vertebral augmentation interventions.
RESULTS
The evidence review identified 3,391 citations, of which 111 clinical reports (4,235 patients) evaluated the effectiveness of vertebroplasty (78 reports, 2,545 patients) or kyphoplasty (33 reports, 1,690 patients) for patients with mixed primary spinal metastatic cancers, multiple myeloma, or hemangiomas. Overall the mean pain intensity scores often reported within 48 hours of vertebral augmentation (kyphoplasty or vertebroplasty), were significantly reduced. Analgesic use, although variably reported, usually involved parallel decreases, particularly in opioids, and mean pain-related disability scores were also significantly improved. In a randomized controlled trial comparing kyphoplasty with usual care, improvements in pain scores, pain-related disability, and health-related quality of life were significantly better in the kyphoplasty group than in the usual care group. Bone cement leakage, mostly asymptomatic, was commonly reported after vertebroplasty and kyphoplasty. Major adverse events, however, were uncommon.
CONCLUSIONS
Both vertebroplasty and kyphoplasty significantly and rapidly reduced pain intensity in cancer patients with vertebral compression fractures. The procedures also significantly decreased the need for opioid pain medication, and functional disabilities related to back and neck pain. Pain palliative improvements and low complication rates were consistent across the various cancer populations and vertebral fractures that were investigated.
Topics: Fractures, Compression; Humans; Kyphoplasty; Neoplasm Metastasis; Neoplasms; Spinal Cord Compression; Spinal Fractures; Treatment Outcome; Vertebroplasty
PubMed: 27298655
DOI: No ID Found -
Orthopaedics & Traumatology, Surgery &... Sep 2015To assess the effectiveness and safety of stentoplasty in people with osteoporotic vertebral body fractures. A systematic search of databases including MEDLINE, EMBASE... (Review)
Review
UNLABELLED
To assess the effectiveness and safety of stentoplasty in people with osteoporotic vertebral body fractures. A systematic search of databases including MEDLINE, EMBASE and Cochrane library, between others, was conducted to June 9, 2014. Clinical trials and observational studies that included alive adults with osteoporotic vertebral body fractures and the comparators were the intervention himself, vertebroplasty or balloon kyphoplasty were selected. Quality of evidence was graded according to the GRADE approach. Two review authors independently selected studies, assessed risk of bias and extracted data. Forty-two citations were identified during the search. After removing duplicates, five studies were included: two clinical trials and three observational studies. Stentoplasty, showed higher rate of adverse events related to material (P=0.043) and cuff pressure (P=0.014) in comparison to kyphoplasty. There was no difference between two procedures in terms of reduction of kyphosis, time of exposure to radiation or postoperative loss of cement. Stentoplasty in comparison to vertebroplasty, showed an improvement of restoration of vertebral height (P=0.042), kyphosis correction and volume of bone cement. No differences were found between two procedures in terms of loss of vertebral body volume. Based on observational studies, stentoplasty improved vertebral height, pain and functional disability at 6 and 12months follow-up, and corrected the angle vertebral fractures in patients with osteoporotic vertebral body. Stentoplasty was presented as a safe procedure in short-medium term, with a low complication rate, a reduced loss of cement and new vertebral body fractures lower rates. Stentoplasty improves vertebral height, reduces the pain and functional disability and correct the vertebral angle in patients with osteoporotic vertebral body fracture with minimum adverse events. Stentoplasty is comparable to kyphoplasty in terms of correction of kyphosis, time of exposure to radiation and cement postoperative loss, and comparable to vertebroplasty in terms of restoration of vertebral height correction and bone cement volume.
LEVEL OF EVIDENCE
Level II systematic review.
Topics: Humans; Kyphoplasty; Osteoporotic Fractures; Pain; Spinal Fractures; Stents
PubMed: 26194207
DOI: 10.1016/j.otsr.2015.06.002 -
Pain Physician 2013Kyphoplasty reduces the pain caused by osteoporotic vertebral compression fracture (OVCF). Although the procedure is typically carried out using a bilateral approach, it... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Kyphoplasty reduces the pain caused by osteoporotic vertebral compression fracture (OVCF). Although the procedure is typically carried out using a bilateral approach, it is now increasingly performed using a unilateral approach because of the concern for long-term adverse effects. However, little evidence is available to demonstrate superior safety of the unilateral approach.
OBJECTIVE
The purpose of this study was to compare the short- and long-term safety and efficacy of unilateral vs. bilateral kyphoplasty.
STUDY DESIGN
A systematic review and meta-analysis of randomized controlled trials.
SETTINGS
MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and abstracts published in the related orthopedic journals were systematically searched up to September 2012, using "unilateral kyphoplasty" and "osteoporotic vertebral compression fractures" as key words.
METHODS
Two investigators independently searched and identified relevant reports and abstracts using the PRISMA statement criteria. Relevant studies cited by the identified papers were also included. The level of evidence was classified as good, fair, and limited (or poor) based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF).
RESULTS
Four randomized controlled trials (RCTs) of 159 cases were enrolled. The methodological quality of the articles was determined as moderate. We did not find any significant difference between unilateral and bilateral kyphoplasty on pain relief, in either short-term or long-term follow-up (P = 0.65 and P = 0.69, respectively). The rate of adjacent vertebral fracture was not statistically different with a P value of 0.88 and 95% CI (confidence intervals) of 0.25-3.26. Cement leakage was comparable between unilateral and bilateral kyphoplasty (P = 0.56, 95% CI = 0.46-4.26). The loss of vertebral height in long-term follow-up was not different (P = 0.10, 95% CI = -0.39-4.54). Operation time and cement dosage were considerably less for unilateral kyphoplasty (P < 0.01 and P < 0.05, respectively).
LIMITATIONS
Only 4 RCTs and 159 patients were included in this systematic review. Publication bias also existed among the studies included.
CONCLUSIONS
Both unilateral and bilateral kyphoplasty are effective in alleviating the back pain caused by OVCF. Two approaches have the same degree of safety. More RCTs are needed to examine the efficacy and adverse reactions of the 2 approaches.
Topics: Back Pain; Bone Cements; Fractures, Compression; Humans; Kyphoplasty; Osteoporosis; Randomized Controlled Trials as Topic; Spinal Fractures
PubMed: 23877445
DOI: No ID Found -
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 -
Diagnostics (Basel, Switzerland) Mar 2023Vertebral body metastases (VBM) are one of the most frequent sites of bone metastasis, and their adequate therapeutic management still represents an insidious challenge... (Review)
Review
Radiofrequency Ablation in Vertebral Body Metastasis with and without Percutaneous Cement Augmentation: A Systematic Review Addressing the Need for SPINE Stability Evaluation.
Vertebral body metastases (VBM) are one of the most frequent sites of bone metastasis, and their adequate therapeutic management still represents an insidious challenge for both oncologists and surgeons. A possible alternative treatment for VBM is radiofrequency ablation (RFA), a percutaneous technique in which an alternating current is delivered to the tumor lesion producing local heating and consequent necrosis. However, RFA alone could alter the biomechanics and microanatomy of the vertebral body, thus increasing the risk of post-procedure vertebral fractures and spine instability, and indeed the aim of the present study is to investigate the effects of RFA on spine stability. A systematic review according to PRISMA-P guidelines was performed, and 17 papers were selected for the systematic review. The results show how RFA is an effective, safe, and feasible alternative to conventional radiotherapy for the treatment of VBM without indication for surgery, but spine stability is a major issue in this context. Although exerting undeniable benefits on pain control and local tumor recurrence, RFA alone increases the risk of spine instability and consequent vertebral body fractures and collapses. Concomitant safe and feasible therapeutic strategies such as percutaneous vertebroplasty and kyphoplasty have shown synergic positive effects on back pain and improvement in spine stability.
PubMed: 36980472
DOI: 10.3390/diagnostics13061164