Vertebroplasty and kyphoplasty for the treatment of vertebral compression fractures: an evidenced-based review of the literature.
BACKGROUND
Vertebroplasty (VP) and kyphoplasty (KP) are routinely used to treat vertebral body compression fractures (VCFs) resulting from osteoporosis or vertebral body tumors in order to provide rapid pain relief. However, it remains debated whether VP or KP results in superior outcomes versus medical management alone in patients experiencing VCFs.


OBJECTIVE
To determine the level of evidence supporting VP or KP for the treatment of VCFs.


METHODS
Systematic review of the literature.


METHODS
Patients with osteoporotic or tumor-associated VCFs.


METHODS
Self-reported and functional measures.


METHODS
We reviewed all articles published between 1980 and 2008 reporting outcomes after VP or KP for osteoporotic or tumor-associated VCFs and rated the level of evidence and grades of recommendation (per North American Spine Society [NASS] guidelines) supporting the use of VP or KP for the treatment of VCFs.


RESULTS
Seventy-four VP studies for osteoporotic VCF (1 level I, 3 level II, 70 level IV), 35 KP studies for osteoporotic VCF (2 level II, 33 level IV), and 18 VP/KP for tumor VCFs (all level IV) were reviewed. There is good evidence (level I) that VP results in superior pain control within the first 2 weeks of intervention compared with optimal medical management for osteoporotic VCFs. There is fair evidence (level II-III) that VP results in less analgesia use, less disability, and greater improvement in general health when compared with optimal medical management within the first 3 months after intervention. There is fair evidence (level II-III) that by 2 years after intervention, VP provides a similar degree of pain control and physical function as optimal medical management. There is fair evidence (level II-III) that KP results in greater improvement in daily activity, physical function, and pain relief when compared with optimal medical management for osteoporotic VCFs by 6 months after intervention. There is poor-quality evidence that VP or KP results in greater pain relief for tumor-associated VCFs.


CONCLUSIONS
Although evidence suggests that physical disability, general health, and pain relief are better with VP and KP than those with medical management within the first 3 months after intervention, high-quality randomized trials with 2-year follow-up are needed to confirm this. Furthermore, the reported incidence of symptomatic procedure-related morbidity for both VP and KP is very low.
McGirt
Matthew J
MJ
Spinal Column Biomechanics and Surgical Outcomes Laboratory, The Johns Hopkins Department of Neurosurgery, 600 N. Wolfe Street, Meyer 8-161, Baltimore, MD 21218, USA. mmcgirt1@jhmi.edu
Parker
Scott L
SL
Wolinsky
Jean-Paul
JP
Witham
Timothy F
TF
Bydon
Ali
A
Gokaslan
Ziya L
ZL
D019317:Evidence-Based Medicine; D050815:Fractures, Compression / Q000209:etiology / Q000601:surgery*; D005598:Fractures, Spontaneous / Q000209:etiology / Q000601:surgery*; D006801:Humans; D010024:Osteoporosis / Q000150:complications; D016103:Spinal Fractures / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome; D054854:Vertebroplasty