title: Comparing effects of kyphoplasty, vertebroplasty, and non-surgical management in a systematic review of randomized and non-randomized controlled studies.
abstract: OBJECTIVE
  To determine if differences in safety or efficacy exist between balloon kyphoplasty (BKP), vertebroplasty (VP) and non-surgical management (NSM) for the treatment of osteoporotic vertebral compression fractures (VCFs).
  
  
  METHODS
  As of February 1, 2011, a PubMed search (key words: kyphoplasty, vertebroplasty) resulted in 1,587 articles out of which 27 met basic selection criteria (prospective multiple-arm studies with cohorts of ≥ 20 patients). This systematic review adheres to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines.
  
  
  RESULTS
  Pain reduction in both BKP (-5.07/10 points, P < 0.01) and VP (-4.55/10, P < 0.01) was superior to that for NSM (-2.17/10), while no difference was found between BKP/VP (P = 0.35). Subsequent fractures occurred more frequently in the NSM group (22 %) compared with VP (11 %, P = 0.04) and BKP (11 %, P = 0.01). BKP resulted in greater kyphosis reduction than VP (4.8º vs. 1.7°, P < 0.01). Quality of life (QOL) improvement showed superiority of BKP over VP (P = 0.04), along with a trend for disability improvement (P = 0.08). Cement extravasation was less frequent in the BKP (P = 0.01). Surgical intervention within the first 7 weeks yielded greater pain reduction than VCFs treated later.
  
  
  CONCLUSIONS
  BKP/VP provided greater pain relief and fewer subsequent fractures than NSM in osteoporotic VCFs. BKP is marginally favored over VP in disability improvement, and significantly favored in QOL improvement. BKP had a lower risk of cement extravasation and resulted in greater kyphosis correction. Despite this analysis being restricted to Level I and II studies, significant heterogeneity suggests that the current literature is delivering inconsistent messages and further trials are needed to delineate confounding variables.
authors.affiliation: H. Lee Moffitt Cancer Center and Research Institute, NeuroOncology Program and Department of Neurosurgery and Orthopaedics, University of South Florida College of Medicine, 12902 Magnolia Drive, Tampa, FL, 33647, USA. jpapa73@yahoo.gr
authors.forename: Ioannis D
authors.initials: ID
authors.lastname: Papanastassiou
authors.forename: Frank M
authors.initials: FM
authors.lastname: Phillips
authors.forename: Jan
authors.initials: J
authors.lastname: Van Meirhaeghe
authors.forename: James R
authors.initials: JR
authors.lastname: Berenson
authors.forename: Gunnar B J
authors.initials: GB
authors.lastname: Andersson
authors.forename: Gary
authors.initials: G
authors.lastname: Chung
authors.forename: Brent J
authors.initials: BJ
authors.lastname: Small
authors.forename: Kamran
authors.initials: K
authors.lastname: Aghayev
authors.forename: Frank D
authors.initials: FD
authors.lastname: Vrionis
mesh_terms: D018849:Controlled Clinical Trials as Topic; D050815:Fractures, Compression / Q000534:rehabilitation* / Q000601:surgery*; D006801:Humans; D058498:Kyphoplasty; D058866:Osteoporotic Fractures / Q000534:rehabilitation / Q000601:surgery; D010146:Pain / Q000453:epidemiology / Q000209:etiology; D016103:Spinal Fractures / Q000534:rehabilitation* / Q000601:surgery*; D054854:Vertebroplasty