A study presented at the annual meeting of the International Society for the Advancement of Spinal Surgery (ISASS; 20–23 March, Barcelona, Spain), by Jan Van Meirhaeghe (AZ Sint-Jan, Brugge-Oostende AV, Dienst Orthopedie en Traumatologie, Brugee, Belgium, showed that vertebral augmentation procedures are associated with greater pain relief and fewer subsequent fractures compared with non-surgical management for the treatment of vertebral compression fractures.
Using PubMed to find relevant studies, Van Meirhaeghe et al identified 27 studies that met their basic criteria of a kyphoplasty or vertebroplasty study that was a prospective, multiple-arm study with cohorts of ≥20 patients. They found that both balloon kyphoplasty and vertebroplasty were more effective at reducing pain than non-surgical management (-5.07/10 points for balloon kyphoplasty vs. -4.55/10 for vertebroplasty vs. -2.17/10 for non-surgical management). Additionally, the vertebral augmentation procedures, compared with non-surgical management, were associated with fewer subsequent fractures: 22% of patients in the non-surgical management arm of the meta-analysis incurred a subsequent fracture compared with 11% of patients in the balloon kyphoplasty arm and 11% of patients in the vertebroplasty arm.
Although there were no significant differences between the balloon kyphoplasty and vertebroplasty groups in terms of pain reduction or rate of subsequent fractures, balloon kyphoplasty significantly reduced kyphosis compared with vertebroplasty (4.8 degrees vs. 1.7 degrees, respectively, p<0.01) and significantly improved quality of life (p=0.04). Additionally, Van Meirhaeghe et al found a trend towards disability improvement with balloon kyphoplasty compared with vertebroplasty (p=0.08). Van Meirhaeghe et al concluded: “Despite this analysis being restricted to level I and II studies, significant heterogeneity suggests that the literature currently does not present a consistent picture of the safety and effectiveness of vertebral augmentation procedures.”
A second study, also presented at ISASS12 by Van Meirhaeghe (again, the lead author), compared balloon kyphoplasty with non-surgical management in patients with acute painful fractures over 24 months. Over the 24-month follow-up period, balloon kyphoplasty was associated with significant improvements in SF-36 physical component summary (PCS) scores and was associated with greater functionality (by assessing timed “up and go”) compared with non-surgical management. Additionally, the interventional treatment significantly improved vertebral body kyphotic angulation: an average of 3.1 degrees of correction vs. 0.8 degrees of correction with non-surgical management (p=0.003).
Van Meirhaeghe said: “There is strong clinical evidence (randomised controlled trial, Level I) supporting balloon kyphoplasty as an effective and early treatment option for patients with painful vertebral compression fractures. It is superior to non-surgical management, and the improvements persist for at least two years. Benefits are: better quality of life, quicker return of back function and mobility, faster back pain relief, and less analgesic use through 12-months.” He added correlation and quartile analysis suggests a relationship between kyphotic correction and clinical outcomes, saying “This means that restauration of the kyphosis goes hand in hand with pain reduction and improvement in quality of life, disability, activity and even survival, as we know from the literature.”