Percutaneous vertebroplasty for osteoporotic vertebral compression fracture

Percutaneous vertebroplasty is widely used to treat acute and subacute painful osteoporotic vertebral fractures although recent placebo-controlled trials have questioned its value. To synthesise the available evidence regarding the benefits and harms of vertebroplasty for treatment of osteoporotic v...

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Bibliographic Details
Published in:Cochrane database of systematic reviews 2015-04 (4), p.CD006349-CD006349
Main Authors: Buchbinder, Rachelle, Golmohammadi, Kamran, Johnston, Renea V, Owen, Richard J, Homik, Joanne, Jones, Allyson, Dhillon, Sukhvinder S, Kallmes, David F, Lambert, Robert G W
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Bone Cements - therapeutic use
Female
Fractures, Compression - therapy
Humans
Male
Middle Aged
Osteoporotic Fractures - therapy
Pain Measurement
Pain, Postoperative
Randomized Controlled Trials as Topic
Spinal Fractures - therapy
Vertebroplasty - methods
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Summary:Percutaneous vertebroplasty is widely used to treat acute and subacute painful osteoporotic vertebral fractures although recent placebo-controlled trials have questioned its value. To synthesise the available evidence regarding the benefits and harms of vertebroplasty for treatment of osteoporotic vertebral fractures. We searched CENTRAL, MEDLINE and EMBASE up to November 2014. We also reviewed reference lists of review articles, trials and trial registries to identify any other potentially relevant trials. We included randomised and quasi-randomised controlled trials (RCTs) including adults with painful osteoporotic vertebral fractures of any duration and comparing vertebroplasty with placebo (sham), usual care, or any other intervention. As it is least prone to bias, vertebroplasty compared with placebo was the primary comparison. Major outcomes were mean overall pain, disability, disease-specific and overall health-related quality of life, patient-reported treatment success, new symptomatic vertebral fractures and number of other serious adverse events. At least two review authors independently selected trials for inclusion, extracted data, performed 'Risk of bias' assessment and assessed the quality of the body of evidence for the main outcomes using GRADE. Eleven RCTs and one quasi-RCT conducted in various countries were included. Two trials compared vertebroplasty with placebo (209 randomised participants), six compared vertebroplasty with usual care (566 randomised participants) and four compared vertebroplasty with kyphoplasty (545 randomised participants). Trial size varied from 34 to 404 participants, most participants were female, mean age ranged between 63.3 and 80 years, and mean symptom duration varied from a week to more than six months.Both placebo-controlled trials were judged to be at low overall risk of bias while other included trials were generally considered to be at high risk of bias across a range of criteria, most seriously due to lack of participant and study personnel blinding.Compared with placebo, there was moderate quality evidence based upon two trials that vertebroplasty provides no demonstrable benefits with respect to pain, disability, disease-specific or overall quality of life or treatment success. At one month, mean pain (on a scale 0 to 10, higher scores indicate more pain) was 5 points with placebo and 0.7 points better (1.5 better to 0.15 worse) with vertebroplasty, an absolute pain reduction of 7% (15% better to 1.5
ISSN:1469-493X
DOI:10.1002/14651858.CD006349.pub2