New vertebral fractures after osteoporotic vertebral compression fracture between balloon kyphoplasty and nonsurgical treatment PRISMA

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Abstract

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Abstract

Background:

Because of aging of population, osteoporotic vertebral compression fracture (OVCF) appears an increasing incidence rate. Conservative therapy (CT) and balloon kyphoplasty (BKP) have been used to treat OVCFs. However, an increase in new vertebral compression fractures at nontreated levels following BKP is of concern. It is still not clear whether new fractures were a result of BKP and the purpose of this meta-analysis was to evaluate the new fractures risk after BKP compared with CT.

Methods:

An exhaustive literature search of PubMed, EMBASE, and the Cochrane Library was conducted to identify randomized controlled trials and prospective nonrandomized controlled study that compared BKP with CT for patients suffering OVCF. A random-effect model was used. Results were reported as standardized mean difference or risk ratio with 95% confidence interval.

Results:

Twelve studies were included and there was no significant difference in total new fractures ( P = .33) and adjacent fractures ( P = .83) between 2 treatments. Subgroup analyses did not demonstrate significant differences in follow-up period, mean age, anti-osteoporosis therapy, and the proportion of women.

Conclusion:

Our systematic review revealed that an increased risk of fracture of vertebral bodies was not associated with BKP compared with CT.

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Most cited references 42

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Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis.

C M Klotzbuecher, P. D. Ross, P B Landsman … (2000)

Numerous studies have reported increased risks of hip, spine, and other fractures among people who had previous clinically diagnosed fractures, or who have radiographic evidence of vertebral fractures. However, there is some variability in the magnitudes of associations among studies. We summarized the literature and performed a statistical synthesis of the risk of future fracture, given a history of prior fracture. The strongest associations were observed between prior and subsequent vertebral fractures; women with preexisting vertebral fractures (identified at baseline by vertebral morphometry) had approximately 4 times greater risk of subsequent vertebral fractures than those without prior fractures. This risk increases with the number of prior vertebral fractures. Most studies reported relative risks of approximately 2 for other combinations of prior and future fracture sites (hip, spine, wrist, or any site). The confidence profile method was used to derive a single pooled estimate from the studies that provided sufficient data for other combinations of prior and subsequent fracture sites. Studies of peri- and postmenopausal women with prior fractures had 2.0 (95 % CI = 1.8, 2.1) times the risk of subsequent fracture compared with women without prior fractures. For other studies (including men and women of all ages), the risk was increased by 2.2 (1.9, 2.6) times. We conclude that history of prior fracture at any site is an important risk factor for future fractures. Patients with a history of prior fracture, therefore, should receive further evaluation for osteoporosis and fracture risk.

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[Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty].

P Galibert, H Deramond, P Rosat … (1987)

Findings in several cases are used to demonstrate that certain vertebral angiomas may not be congenital and can ultimately provoke medullary or radicular neurologic complications. Radiotherapy is the usual treatment but is not always accepted unconditionally close to spinal cord. Destruction of angioma and consolidation of vertebral column can be obtained by percutaneous intrasomatic injection of acrylic cement. The preoperative radiologic examination includes direct phlebography with insertion of trocar, the vertebroplasty being performed under television screen surveillance. Results in seven patients treated are very encouraging but the current 2-year follow up requires extension. However, the method appears to be able to be included amongst treatment for an affection of sometimes seriously questioned benign nature.

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New technologies in spine: kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures.

H Yuan, M Reiley, Steven Garfin (2001)

Literature review. To describe new treatments for painful osteoporotic compression fractures in light of available scientific literature and clinical experience. Painful vertebral osteoporotic compression fractures lead to significant morbidity and mortality. This relates to pulmonary dysfunction, eating disorders (nutritional deficits), pain, loss of independence, and mental status change (related to pain and medications). Medications to treat osteoporosis (primarily antiresorptive) do not effectively treat the pain or the fracture, and require over 1 year to reduce the degree of osteoporosis. Kyphoplasty and vertebroplasty are new techniques that help decrease the pain and improve function in fractured vertebrae. This is a descriptive review of the background leading to vertebroplasty and kyphoplasty, a description of the techniques, a review of the literature, as well as current ongoing studies evaluating kyphoplasty. Both techniques have had a very high acceptance and use rate. There is 95% improvement in pain and significant improvement in function following treatment by either of these percutaneous techniques. Kyphoplasty improves height of the fractured vertebra, and improves kyphosis by over 50%, if performed within 3 months from the onset of the fracture (onset of pain). There is some height improvement, though not as marked, along with 95% clinical improvement, if the procedure is performed after 3 months. Complications occur with both and relate to cement leakage in both, and cement emboli with vertebroplasty. Kyphoplasty and vertebroplasty are safe and effective, and have a useful role in the treatment of painful osteoporotic vertebral compression fractures that do not respond to conventional treatments. Kyphoplasty offers the additional advantage of realigning the spinal column and regaining height of the fractured vertebra, which may help decrease the pulmonary, GI, and early morbidity consequences related to these fractures. Both procedures are technically demanding.

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Author and article information

Journal

Journal ID (nlm-ta): Medicine (Baltimore)

Journal ID (iso-abbrev): Medicine (Baltimore)

Journal ID (publisher-id): MEDI

Title: Medicine

Publisher: Wolters Kluwer Health

ISSN (Print): 0025-7974

ISSN (Electronic): 1536-5964

Publication date Collection: October 2018

Publication date (Electronic): 05 October 2018

Volume: 97

Issue: 40

Electronic Location Identifier: e12666

Affiliations

[a ]Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University, Anhui

[b ]Department of Orthopedics, the First Affiliated Hospital of USTC (AnHui Provincial Hospital), China.

Author notes

[∗ ]Correspondence: Cai-Liang Shen, Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University, 210 Jixi Road, Hefei, Anhui 230022, China (e-mail: shencailiang1616@ 123456163.com ).

Article

Publisher ID: MD-D-18-00701 Accession ID: 12666

DOI: 10.1097/MD.0000000000012666

PMC ID: 6200511

PubMed ID: 30290650

SO-VID: 8077224a-f908-4459-8f67-412292c99393

License:

This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0

History

Date received : 25 January 2018

Date accepted : 13 September 2018

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Keywords: balloon kyphoplasty,conservative treatment,kyphoplasty,meta-analysis,new osteoporotic compression vertebral fracture

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Keywords: balloon kyphoplasty, conservative treatment, kyphoplasty, meta-analysis, new osteoporotic compression vertebral fracture

New vertebral fractures after osteoporotic vertebral compression fracture between balloon kyphoplasty and nonsurgical treatment PRISMA

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China Tropical Medicine

Most cited references 42

Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis.

[Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty].

New technologies in spine: kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures.

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