Percutaneous vertebroplasty for osteoporotic vertebral compression fracture

Buchbinder, Rachelle; Johnston, Renea V; Rischin, Kobi J; Homik, Joanne; Jones, Chelsea; Golmohammadi, Kamran; Kallmes, David F.

doi:10.1002/14651858.cd006349.pub4

Cited by 59 publications

(33 citation statements)

References 110 publications

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“…[4,5] Because meta-analysis can offer the highest level of scientific evidence about the efficacy of an intervention based on the principles of evidence-based medicine, in 2015, Buchbinder et al included 11 randomized controlled trials (RCTs) and 1 quasi-RCT conducted in various countries in another study. [6–8] This review did not support a role for vertebroplasty in the treatment of osteoporotic vertebral fractures in routine practice. In addition, this procedure was indicated to be incapable of restoring the initial height of the vertebral body.…”

Section: Introductionmentioning

confidence: 91%

Unilateral versus bilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures

Chang

Zhang²,

Jiao³

et al. 2017

Medicine

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Background:The debate on the efficacy of unilateral percutaneous kyphoplasty (UPKP) and bilateral percutaneous kyphoplasty (BPKP) for the treatment of osteoporotic vertebral compression fractures (OVCFs) is ongoing.This meta-analysis aimed to evaluate the clinical results of UPKP and BPKP in the treatment of OVCFs.Methods:Web of Science, PubMed, Embase, and the Chinese Biomedical Database publication databases were searched using a date range of January 2008 to November 2016, for studies comparing UPKP and BPKP for the treatment of OVCFs. The clinical effectiveness was assessed by comparing perioperative outcomes (surgery time, the volume of injected cement, X-ray exposure time, and kyphotic angle reduction), clinical outcomes (visual analogue scale [VAS] for pain relief and Oswestry Disability Index [ODI] for quality of life), and surgery-related complications (cement leakage and adjacent vertebral fractures). Data were analyzed using Stata/SE11.0 software.Results:Fourteen trials with 1194 patients were retrieved. The pooled results showed significant differences in surgery time (weighted mean difference [WMD] −21.44, 95% confidence interval [CI] [−23.57 to −19.30]; P < .001); volume of injected cement [WMD −1.90, 95% CI [−2.26 to −1.54); P < .001); and X-ray exposure time (WMD −13.66, 95%CI [−19.59 to −7.72]; P < .001) between UPKP and BPKP treatments. However, the pooled results showed no significant differences in kyphotic angle reduction, VAS in the short-term, VAS in the long-term, ODI, cement leakage, or adjacent vertebral fractures between the 2 surgical procedures. Following a subgroup analysis, the results based on randomized controlled trials (RCTs) indicated that there were significant differences in surgery time (WMD −24.65, 95%CI [−26.53 to −22.77]; P < .001) and the volume of injected cement (WMD −1.66, 95%CI [−1.97 to −1.36]; P < .001) between UPKP and BPKP treatment procedures, respectively. The results based on RCTs indicated that there were no significant differences, either in kyphotic angle reduction or in X-ray exposure time, between the 2 surgical procedures.Conclusions:Compared to BPKP procedures, UPKP procedures may achieve similar clinical results in the treatment of OVCFs when assessed in terms of the pain relief, improvements in life quality, and surgery-related complications. However, UPKP procedures had a shorter operation time and volume of injected cement compared with BPKP procedures. Additional high quality and multicenter RCTs are needed to provide further robust evidence.

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Section: Introductionmentioning

confidence: 91%

Unilateral versus bilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures

Chang

Zhang²,

Jiao³

et al. 2017

Medicine

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“…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 . High‐ to moderate‐quality 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.…”

Section: Three Additional Trials Fail To Overturn Conclusion From Thmentioning

confidence: 99%

“…Many hundreds of thousands of patients have received vertebroplasty since the first two high quality randomised trials were published, and many harms have been reported. While the small number of events in controlled trials means there is uncertainty around the exact risk estimates of harms from vertebroplasty, reported harms include infection, rib fractures, further vertebral fractures, cement emboli lodging in the lung or piercing the heart, paralysis and death . A pooled estimate based on data from six controlled trials has suggested that vertebroplasty may be associated with a higher number of new symptomatic vertebral fractures compared with controls (48/418 (95 per 1000; range 34–264) compared with 31/422 (73 per 1000), risk ratio 1.29 (95% confidence interval 0.46–3.62)), although this analysis is also underpowered and therefore uncertain.…”

Section: First Do No Harmmentioning

confidence: 99%

Why we should stop performing vertebroplasties for osteoporotic spinal fractures

Buchbinder

Busija

2019

Internal Medicine Journal

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While vertebroplasty enjoys continued use in some settings, there is now high‐moderate quality evidence based on systematic review that includes five placebo‐controlled trials that it provides no benefits over placebo and these results do not differ according to pain duration (≤6 vs >6 weeks). A clinically important increased risk of incident symptomatic vertebral fractures or other serious adverse events cannot be excluded due to small event numbers. Serious harms including cord compression, ventricular perforation, pulmonary embolism, infection and death have been reported. This unfavourable risk–benefit ratio should be convincing doctors and patients to stop the use of vertebroplasty. At the very least, clinicians should fully inform their patients about the evidence including the likelihood of improving without vertebroplasty and the potential harms, so that patients can make evidence‐informed decisions about their treatment. They should also warn patients about the pitfalls of relying on information sourced from the internet or from ‘awareness raising’ campaigns.

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“…The first Cochrane review for vertebroplasty was published in 2015 . This also detailed the review protocol which has not been updated and still applies to the more recent Cochrane review published in 2018.…”

Section: Meta‐analysesmentioning

confidence: 99%

“…This also detailed the review protocol which has not been updated and still applies to the more recent Cochrane review published in 2018. This included 21 trials and declared that high‐ to moderate‐quality evidence suggested vertebroplasty provides no clinically important benefits with respect to pain, disability, QoL or treatment success after 1 month . No mention was made of these outcomes after this time point.…”

Section: Meta‐analysesmentioning

confidence: 99%

Vertebroplasty for acute painful osteoporotic vertebral compression fractures: An update

et al. 2019

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Summary Vertebral compression fractures (VCFs) are a common cause of back pain and disability and are usually osteoporotic in nature. Therapy aims to adequately control pain and allow early mobilisation and return of function while preventing additional fractures. A proportion of patients do not achieve adequate pain relief using conservative measures alone. Unwanted adverse effects from medications may also ensue. Vertebroplasty represents an alternative treatment option for VCFs. Patients with acute VCFs (≤6 weeks old) may gain the most benefit from vertebroplasty as healed fractures are not as amenable to cement injection. High‐quality studies have reported conflicting results regarding the use of vertebroplasty in the treatment of acute VCFs. Despite high‐quality evidence, varying study designs and heterogenous patient cohorts make interpretation of this data difficult. Only one sham‐controlled randomised controlled trial (RCT) has evaluated vertebroplasty exclusively in patients with acute VCFs, reporting favourable results. Pooled data from RCTs also suggest vertebroplasty to be safe. This article provides a concise and critical review of the current literature regarding vertebroplasty for the treatment of acute VCFs.

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Percutaneous vertebroplasty for osteoporotic vertebral compression fracture

Abstract: Analysis 1.1. Comparison 1 Efficacy: Vertebroplasty versus placebo (sham), Outcome 1 Pain (0 to 10 point scale).. Analysis 1.2. Comparison 1 Efficacy: Vertebroplasty versus placebo (sham), Outcome 2 Proportion of participants with pain improved by a clinically relevant amount (>2.

Cited by 59 publications

References 110 publications

Unilateral versus bilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures

Unilateral versus bilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures

Why we should stop performing vertebroplasties for osteoporotic spinal fractures

Vertebroplasty for acute painful osteoporotic vertebral compression fractures: An update

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