A working group of the International Osteoporosis Foundation (IOF) has issued a literature review of prospective controlled studies comparing the efficacy and safety of vertebroplasty and balloon kyphoplasty for vertebral augmentation after spine fracture versus non surgical management. The review has been published in Osteoporosis International.
To evaluate the management of osteoporotic vertebral compression fractures with vertebroplasty, balloon kyphoplasty and non surgical procedures, Boonen et al focused on clinical outcomes including: pain reduction, improvement of function and mobility, vertebral height restoration and decrease in spinal curvature (kyphosis).
The results showed that overall, vertebroplasty and balloon kyphoplasty are relatively safe procedures and serious complications are rare. The researchers also found that, in the short term, both procedures provide quicker pain relief and mobility recovery than conservative treatment alone. “However, the long-term benefits and safety in terms of risk of subsequent vertebral fractures have not been clearly demonstrated and further prospective randomised studies are needed with standards for reporting,” researchers wrote.
Kristina Åkesson, chair of the International Osteoporosis Foundation Fracture Working Group and professor at the Department of Orthopedics, Skåne University Hospital Malmö, Sweden, stated, “Referring physicians should be aware that vertebroplasy and ballon kyphoplasty are available options for the management of vertebral compression fractures, with possible clinical benefits to their patients in terms of acute pain relief and improved quality of life. However, longer follow-up of patients are needed to ensure the efficacy and safety of these techniques, which should not be considered as a substitute for the medical management of osteoporosis, vitally needed in these patients at high risk of other fractures.”
Researchers also found:
- Vertebroplasty and balloon kyphoplasty are able to stabilise the fracture and in some cases restore lost vertebral body height.
- The added benefit of injecting cement over a sham-controlled surgery is still contentious.
- The clinical outcome after vertebroplasty and balloon kyphoplasty appears to be dependent on the time elapsed between the fracture and the intervention.
- The incidence of new (including adjacent) vertebral fractures are similar after vertebroplasty or balloon kyphoplasty, but longer term data are required.