Journal ArticleDOI
Balloon kyphoplasty and vertebroplasty for vertebral compression fractures: a comparative systematic review of efficacy and safety.
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TLDR
There is Level III evidence to support balloon kyphoplasty and vertebroplasty as effective therapies in the management of patients with symptomatic osteoporotic vertebral compression fractures refractory to conventional medical therapy.Abstract:
Study design Systematic review and meta-regression. Objectives To compare the efficacy and safety of balloon kyphoplasty and vertebroplasty for the treatment of vertebral compression fractures, and to examine the prognostic factors that predict outcome. Summary of background data A previous systematic review of vertebroplasty by Levine et al in 2000 identified seven case series studies and no controlled studies. Methods A number of electronic databases were searched through March 1, 2004. Citation searches of included studies were undertaken and contact was made with experts in the field. No language restrictions were applied. All controlled and uncontrolled studies were included with the exception of case reports. Prognostic factors responsible for pain relief and cement leakage were examined using meta-regression. Results The following studies were included: balloon kyphoplasty (three nonrandomized comparative studies against conventional medical therapy and 13 case series), vertebroplasty (one nonrandomized comparative study against conventional medical care and 57 cases series), balloon kyphoplasty versus vertebroplasty (one nonrandomized comparative study). The majority of studies were undertaken in older women with osteoporotic vertebral compression fractures with long-term pain that was refractory to medical treatment. At this time, there is no good quality direct comparative evidence of balloon kyphoplasty versus vertebroplasty. From indirect comparison of case series evidence, the procedures appear to provide similar gains in pain relief while for balloon kyphoplasty there is better documentation of gains in patient functionality and quality of life. The level of cement leakage and number of reported adverse events (pulmonary emboli and neurologic injury) in balloon kyphoplasty was significantly lower than for vertebroplasty. These findings were confirmed by meta-regression analysis. Conclusions There is Level III evidence to support balloon kyphoplasty and vertebroplasty as effective therapies in the management of patients with symptomatic osteoporotic vertebral compression fractures refractory to conventional medical therapy. Although there was a good ratio of benefit to harm for both procedures, balloon kyphoplasty appears to offer the better adverse event profile. These conclusions need to be updated on the basis of the findings of ongoing randomized controlled trials.read more
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Journal ArticleDOI
Comparison of vertebroplasty and balloon kyphoplasty for treatment of vertebral compression fractures: a meta-analysis of the literature.
TL;DR: Vertebroplasty had a significantly greater improvement in pain scores but also had statistically greater risk of cement leakage and new fracture, while kyphoplasty provided significant improvement in VAS pain scores.
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Validity of indirect comparison for estimating efficacy of competing interventions: empirical evidence from published meta-analyses
TL;DR: Results of adjusted indirect comparison usually, but not always, agree with those of head to head randomised trials The validity ofadjusted indirect comparisons depends on the internal validity and similarity of the trials involved.
Journal ArticleDOI
Complications associated with the technique of pedicle screw fixation. A selected survey of ABS members.
TL;DR: It is concluded that pedicle screw placement may be associated with significant intraoperative and postoperative complications and is of value to surgeons using pedicle implant systems as well as to their patients.