PURPOSE: To compare complications of percutaneous vertebroplasty (PVP) and balloon kyphoplasty (BKP) for the treatment of osteoporotic vertebral compression fractures (OVCFs).
BACKGROUND: PVP and BKP are two minimally invasive procedures for treating OVCFs, while few studies emphases attention to intra- and post-operative complications about the two procedures.
METHODS: Online databases were searched for studies comparing complications of PVP and BKP for OVCFs, the randomized controlled trials, clinical controlled trials and cohort studies that provided related data were identified. Demographic characteristics and complications related to procedures were extracted and analysed from all of the included studies.
RESULTS: Nineteen studies encompassing 1,787 patients in total, of whom 887 received PVP and 900 received BKP, met the inclusion criteria. For subsequent fractures, our meta-analysis detected no significant difference between the two procedures, both for adjacent fractures (p = 0.29) and non-adjacent fractures (p = 0.37). For cement extravasations, there was no significant difference between the two interventions if considering disc spaces extravasations only (p = 0.24), while considering total extravasations and paravertebral extravasations, the cement leakage rate in the PVP group was significantly higher than the BKP group (total: p < 0.01; paravertebral: p < 0.01).
CONCLUSIONS: The two procedures suffer from equal risk of subsequent spinal fractures; PVP has a significant higher cement leakage rate compared to BKP, mainly caused by a higher paravertebral leakage, patients with extremely poor pulmonary function or unstable haemodynamic are better candidates for BKP.
Journal»European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
PURPOSE: To 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).
METHODS: As 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.
RESULTS: Pain 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.
CONCLUSIONS: BKP/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.
To compare complications of percutaneous vertebroplasty (PVP) and balloon kyphoplasty (BKP) for the treatment of osteoporotic vertebral compression fractures (OVCFs).
BACKGROUND:
PVP and BKP are two minimally invasive procedures for treating OVCFs, while few studies emphases attention to intra- and post-operative complications about the two procedures.
METHODS:
Online databases were searched for studies comparing complications of PVP and BKP for OVCFs, the randomized controlled trials, clinical controlled trials and cohort studies that provided related data were identified. Demographic characteristics and complications related to procedures were extracted and analysed from all of the included studies.
RESULTS:
Nineteen studies encompassing 1,787 patients in total, of whom 887 received PVP and 900 received BKP, met the inclusion criteria. For subsequent fractures, our meta-analysis detected no significant difference between the two procedures, both for adjacent fractures (p = 0.29) and non-adjacent fractures (p = 0.37). For cement extravasations, there was no significant difference between the two interventions if considering disc spaces extravasations only (p = 0.24), while considering total extravasations and paravertebral extravasations, the cement leakage rate in the PVP group was significantly higher than the BKP group (total: p < 0.01; paravertebral: p < 0.01).
CONCLUSIONS:
The two procedures suffer from equal risk of subsequent spinal fractures; PVP has a significant higher cement leakage rate compared to BKP, mainly caused by a higher paravertebral leakage, patients with extremely poor pulmonary function or unstable haemodynamic are better candidates for BKP.
