Vertebral augmentation surgeries—such as vertebroplasty and kyphoplasty—for the treatment of cancer-related spinal compression fractures are associated with statistically significant positive outcomes, particularly when compared to nonsurgical management, radiofrequency ablation, or chemotherapy alone. These are the key findings from a meta-analysis published in the journal Spine by Ryan Mattie (Providence Cedars-Sinai Tarzana Medical Centre, Los Angeles, USA) et al.
The study compared the magnitude and duration of pain relief with vertebral augmentation to any other therapy for the treatment of cancer-related vertebral compression fractures through a meta-analysis of randomised controlled trials (RCTs).
The meta-analysis included studies from the PubMed, EMBASE, CINAHL, Scopus, Central, Scopus, and Web of Science databases. Those selected were limited to RCTs comparing either balloon kyphoplasty or percutaneous vertebroplasty (PVP) with or without additional therapy to any other intervention or placebo/sham.
Out of the 180 studies identified, seven were considered relevant. These seven included a total of 476 participants and the researchers note that the risk of bias was considered “low” in all studies.
In five of the studies, vertebral augmentation alone comprised one group, while comparative treatments included nonsurgical management, Kiva implantation, PVP and radiofrequency therapy, PVP and chemotherapy, PVP and intrasomatic injection of steroid, and PVP with Iodine-125 seeds. The remaining two studies compared PVP with an additional therapy against the standard of care.
Findings from the meta-analysis showed that, with regard to changes in pain severity, the effect sizes varied from 0 (95% confidence interval [CI], –1.7 to 1.7) to –5.1 (95% CI, –5.3 to –4.9). The majority of the studies demonstrated a positive and statistically significant effect associated with PVP. In addition, four of the seven studies demonstrated a clinically significant effect. Other than cement leakage, with an event rate of 0.24 (95% CI, 0.11–0.44) or 24% (95% CI, 11%–44%), there were no major adverse events consistently observed across the studies.