title: Adverse prognostic factors and optimal intervention time for kyphoplasty/vertebroplasty in osteoporotic fractures.
abstract: BACKGROUND
  While evidence supports the efficacy of vertebral augmentation (kyphoplasty and vertebroplasty) for the treatment of osteoporotic fractures, randomized trials disputed the value of vertebroplasty. The aim of this analysis is to determine the subset of patients that may not benefit from surgical intervention and find the optimal intervention time.
  
  
  METHODS
  27 prospective multiple-arm studies with cohorts of more than 20 patients were included in this meta-analysis. We hereby report the results from the metaregression and subset analysis of those trials reporting on treatment of osteoporotic fractures with kyphoplasty and/or vertebroplasty.
  
  
  RESULTS
  Early intervention (first 7 weeks after fracture) yielded more pain relief. However, spontaneous recovery was encountered in hyperacute fractures (less than 2 weeks old). Patients suffering from thoracic fractures or severely deformed vertebrae tended to report inferior results. We also attempted to formulate a treatment algorithm.
  
  
  CONCLUSIONS
  Intervention in the hyperacute period should not be pursued, while augmentation after 7 weeks yields less consistent results. In cases of thoracic fractures and significant vertebral collapse, surgeons or interventional radiologists may resort earlier to operation and be less conservative, although those parameters need to be addressed in future randomized trials.
authors.affiliation: H. Lee Moffitt Cancer Center & Research Institute, Neurooncology Program and Department of Neurosurgery and Orthopaedics, University of South Florida College of Medicine, 12902 Magnolia Drive, Tampa, FL 33647, USA ; General Oncological Hospital "Agioi Anargyroi", 14564 Athens, Greece.
authors.forename: Ioannis D
authors.initials: ID
authors.lastname: Papanastassiou
authors.affiliation: H. Lee Moffitt Cancer Center & Research Institute, Neurooncology Program and Department of Neurosurgery and Orthopaedics, University of South Florida College of Medicine, 12902 Magnolia Drive, Tampa, FL 33647, USA.
authors.forename: Andreas
authors.initials: A
authors.lastname: Filis
authors.affiliation: H. Lee Moffitt Cancer Center & Research Institute, Neurooncology Program and Department of Neurosurgery and Orthopaedics, University of South Florida College of Medicine, 12902 Magnolia Drive, Tampa, FL 33647, USA.
authors.forename: Kamran
authors.identifier: 0000-0002-5085-8115
authors.initials: K
authors.lastname: Aghayev
authors.affiliation: "Attikon" Hospital, Department of Orthopedics, Athens University Medical School, 12462 Athens, Greece.
authors.forename: Zinon T
authors.initials: ZT
authors.lastname: Kokkalis
authors.affiliation: "Andreas Syngros" Hospital, 16121 Athens, Greece.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Gerochristou
authors.affiliation: H. Lee Moffitt Cancer Center & Research Institute, Neurooncology Program and Department of Neurosurgery and Orthopaedics, University of South Florida College of Medicine, 12902 Magnolia Drive, Tampa, FL 33647, USA.
authors.forename: Frank D
authors.initials: FD
authors.lastname: Vrionis
mesh_terms: D002986:Clinical Trials as Topic; D006801:Humans; D058498:Kyphoplasty; D010024:Osteoporosis / Q000473:pathology / Q000601:surgery*; D058866:Osteoporotic Fractures / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D054854:Vertebroplasty