Percutaneous vertebroplasty for osteoporotic vertebral compression fracture

Abstract

Based upon high- to moderate-quality evidence, our updated review does not support a role for vertebroplasty for treating acute or subacute osteoporotic vertebral fractures in routine practice. We found no demonstrable clinically important benefits compared with placebo (sham procedure) and subgroup analyses indicated that the results did not differ according to duration of pain ≤ 6 weeks versus > 6 weeks.Sensitivity analyses confirmed that open trials comparing vertebroplasty with usual care are likely to have overestimated any benefit of vertebroplasty. Correcting for these biases would likely drive any benefits observed with vertebroplasty towards the null, in keeping with findings from the placebo-controlled trials.Numerous serious adverse events have been observed following vertebroplasty. However due to the small number of events, we cannot be certain about whether or not vertebroplasty results in a clinically important increased risk of new symptomatic vertebral fractures and/or other serious adverse events. Patients should be informed about both the high- to moderate-quality evidence that shows no important benefit of vertebroplasty and its potential for harm.

Pelvic fractures: epidemiology, consequences, and medical management

“…Alternative to surgery: sacroplasty Percutaneous vertebroplasty is widely used to treat acute and subacute painful osteoporotic vertebral fractures, although the benefit remains debated [28]. In addition to its use in the thoracic and lumbar Epidemiology, consequences, and medical management Breuil et al spine, sacroplasty is a percutaneous procedure with injection of cement into sacral wings to relieve sacral insufficiency fracture-related pain.…”

Efficacy of Vertebral Augmentation for Vertebral Compression Fractures: A Review of Meta-Analyses

“…Of the seven meta-analyses that compared only VP with control, two concluded that no statistical difference in pain outcomes could be seen between VP and control group. 12,17 The remaining five all concluded that VP reduced pain significantly more than in control groups.…”

“…Of the 10 meta-analyses, three compared both VP and KP against control cohort [8][9][10] and seven compared VP to control cohorts. [11][12][13][14][15][16][17] Characteristics and findings of the 10 studies are summarized in Table 1. When combined, the 10 meta-analyses examined a total of 22 trials.…”

Why we should stop performing vertebroplasties for osteoporotic spinal fractures

“…23 However, leaving aside these potential issues, when data from all five trials were combined in an updated Cochrane review, there was remarkable consistency in results across trials as evident by the paucity of statistical heterogeneity in pooled analyses. 24 High-to moderatequality evidence based on the five placebo-controlled trials found that vertebroplasty provides no demonstrable clinically important benefits over placebo in terms of pain, disability, disease-specific or overall quality of life or participant-rated global assessment of treatment success.…”