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Anesthesiology, Neurological Surgery, and Orthopedic Surgery
Henry Ford Health System and Wayne State University School of Medicine
Background: Back pain is a leading cause of morbidity in older US adults, especially those with osteoporosis. Osteoporotic vertebral compression fractures (OVCF) commonly occur in people with osteoporosis. ~1/3 of OVCF are symptomatic with acute or chronic low back pain. Annual US cases of osteoporosis with OVCF are ~700,000/year. OVCF and osteoporosis cause high levels of morbidity, decreased functional independence, and chronic pain. Conservative treatment for OVCF is often insufficient for many patients. Insufficient vertebral height caused by OVCF can lead to spinal deformities, reduced pulmonary function, depression, reduced mobility, and lower quality of life. Surgical correction is a viable option for increasing vertebral height in patients with OVCF.
Kyphoplasty and vertebroplasty are vertebral augmentation therapies that can restore bone height for the alleviation of OVCF. Both procedures involve injection of a polymer cement into sites of fracture. Only kyphoplasty involves using an inflatable balloon to first make space for polymer injection. These minimally invasive procedures are recommended for patients who have OVCF but are refractory to conventional therapies. Also, patients with benign bone tumors or traumatic acute vertebral compression fractures with a local kyphotic angle greater than 15 degrees can benefit from these procedures. The aim of our systematic review was to identify the overall effectiveness of kyphoplasty and vertebroplasty. Height restoration after treatment was used as the key indicator of therapeutic success. Restoration of function and pain relief were also assessed.
Purpose: To critically investigate whether vertebral body height restoration correlates with pain relief after kyphoplasty and vertebroplasty. Primary Outcome: height restoration. Secondary Outcomes: pain relief, functionality, cement leakage, Cobb’s Angle, wedge angle restoration, kyphosis angle restoration, and Gardner’s angle. We assessed only randomized controlled trials (RCTs) to generate a more robust and clinically applicable. We also provide an update on the literature comparing kyphoplasty versus vertebroplasty for height restoration, pain relief, and function restoration. We searched 6 databases to ensure that the review was comprehensive.
Methods: We performed a systematic review per the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) protocol. Level II randomized controlled trials assessing kyphoplasty and/or vertebroplasty were included. Study selection inclusion criteria: patients > 18 years, in English, study of OVCF, active comparator vs placebo, outcome measure of height restoration, with pain relief and functionality as secondary outcomes. Of 4147 individual articles, 238 articles were screened, and 33 were analyzed. Of the 33 analyzed studies, 6 compared kyphoplasty to vertebroplasty.
Vertebral Height Restoration
7 studies of vertobroplasty
2 showed height loss
1 showed height restoration
2 showed absolute height gain
20 studies of kyphoplasty
None showed height loss
8 showed height restoration
8 showed absolute height gain
6 head-to-head comparisons
3 showed correlation of cement injection volume with improved height
5 favored kyphoplasty for height restoration
Alleviation of Pain:
Assessed by visual analogue scale (VAS)score
6 of 6 vertebroplasty studies showed reduced postop pain
6 of 18 kyphoplasty studies showed sustained reduced pain at 12 months
6 studies compared kyphoplasty & vertebroplasty and none saw a difference between the 2 for reducing postop pain
Restoration of Function
Assessed by Oswestry disability index (ODI)
3 studies showed improved ODI after vertebroplasty at 18 to 36 months postop
4 studies showed improved ODI at 12 months after kyphoplasty
3 studies compared kyphoplasty & vertebroplasty and all showed lower postop ODI
Conclusions: Both kyphoplasty and vertebroplasty are effective treatments for OVCF and are viable options for OVCF patients. Both treatments restored some vertebral body height, reduced kyphosis angle, improved Cobbs angle, and improved wedge angle. Both treatments showed similar benefits of pain reduction and improved functionality. It was unclear whether fracture type or age of fracture influence procedure outcomes. Kyphoplasty has the possibility of cement leakage, which can lead to negative outcomes. It was not possible to conclude whether one approach was superior.
Patel, Nimesh; Jacobs, David; John, Jessin; Nerusu, Lakshmi; Tandron, Marissa; Dailey, William; Ayala, Ricardo; Sibai, Nabil; Forrest, Patrick B.; Schwalb, Jason M.; Pahuta, Markian A.; and Aiyer, Rohit, "Kyphoplasty vs Vertebroplasty: A Systematic Review of Height Restoration in Osteoporotic Vertebral Compression Fractures" (2021). Surgery & Anesthesia Research Celebration Day 2021. 4.