Review Article

Controversial Issues in Kyphoplasty and Vertebroplasty in Osteoporotic Vertebral Fractures

Table 2


Author/year of publicationBaseline characteristicsPain reliefDisabilityQoLKyphotic angle/VH Cement
leakage
New fracturesConclusion

(1) Grafe et al. 2005 [16]/2008 [15]; Kasperk et al. 2005 [18]/2010 [17](1) BKP (40) versus NSM (20)  
(2) Chronic number
(3) Postop, 3 mo, 6 mo, 1 y, 3 y
Pain score (0–100)
BKP superior to NSM( : .008 at 1 y, : .02 at 3 y)
EVOS
NS difference
NRBKP superior to NSM ( )9%, none symptomaticBKP superior to NSM ( : .03 at 3 y)BKP reduces pain, new VCFs, and doctor’s visits in chronic osteoporotic VCFs for at least 1 year.
Both PMMA and CaP equally effective in reducing pain and improving mobility. CaP is better for young pts

(2) Komp et al. 2004 [20](1) BKP (21) versus NSM (19)  
(2) Acute number
(3) 6 w, 6 mo
VAS score
BKP superior to NSM ( : NR)
ODI
BKP superior to NSM ( : NR)
NRNRPoorly reportedBKP: 36%
NSM: 64%
: NR
BKP is superior to NSM

(3) Dong et al. 2009 [31]
(1) BKP (20) versus VP (18)  
(2) NR
(3) Postop, 3 mo
VAS score
BKP equivalent to VP
NR
BKP improved VC more than VP ( )
NRBKP superior to VP ( ) NRNRBoth procedures have significant pain relief and improve lung function; BKP improves vital capacity more than VP

(4) Grohs et al. 2005 [41] (1) BKP (28) versus VP (23)  
(2) Subacute number
(3) Postop, 4 mo, 1 y, 2 y
VAS score
BKP superior to VP ( < .05)
ODI
BKP: superior to NSM ( ) except from 2 y (NS)
NRBKP: 6% decrease ( )
VP: No decrease
BKP: 22.8%, asymptomatic
VP: 27.5%
BKP: 17%
VP: 3.5%
In subacute number BKP is superior in reducing the kyphotic wedge and pain for 2 y. Disability improvement was superior up to 1 yr

(5) Lovi et al. 2009 [32] (1) BKP (36) versus VP (118)  
(2) Acute number
(3) 1 mo, 3 mo, 6 mo,  2 y
VAS score
BKP equivalent to VP
ODI
BKP equivalent to VP
NRBKP had more restoration than VPBKP less extravasation than VP  ( )BKP: none
VP: 3.3%,
( : NR)
Similar pain relief and
function score
BKP less cement leakage

(6) De Negri et al. 2007 [30] (1) BKP (15) versus VP (18)  
(2) Acute and subacute
(3) Postop, 2 days, 1 mo, 3 mo, 6 mo
VAS score
BKP equivalent to VP
ODI
BKP equivalent to VP
NRNRBKP: NONE
VP: 33%
NRThere is no difference between two groups in pain relief and disability improvement.
Cement leakage occurs in VP

(7) Pflugmacher et al. 2005 [34] (1) BKP (22) versus VP (20)  
(2) Acute number
(3) Postop, 3 mo, 6 mo, 1 y
VAS score
BKP equivalent to VP
ODI
BKP equivalent to VP
NRBKP superior to VP  ( )NRNRBKP restore significant body height in acute number

(8) Röllinghof et al.
2009 [35]
(1) BKP (49) versus VP (41)  
(2) Acute number
(3) Preop, postop, 1 y
VAS score
BKP equivalent to VP
ODI
BKP equivalent to VP
NRBKP equivalent to VP in kyphosis reduction BKP superior to VP in height restoration
( )
BKP: 22.6
VP: 25.5%
BKP: 13.2% VP: 7.8%Mean vertebral body height restoration was significantly higher in BKP.

(9) Santiago et al. 2010 [37] (1) BKP (22) versus VP (20)  
(2) Acute number
(3) 1 mo, 6 mo, 1 y
VAS score
BKP equivalent to VP
ODI
BKP equivalent to VP
NRBKP equivalent to VPBKP equivalent to VPBKP superior to VP( : .01)No difference between operations

(10) Schofer et al. 2009 [36] (1) BKP (30) versus VP (30)  
(2) Acute number
(3) 1 d, last follow-up
VAS score
BKP equivalent to VP
NRSF36
BKP equivalent to VP
BKP superior to VP ( ). BKP less extravasation than VP  ( )BKP: none
VP: 3.3%
Similar pain relief. and QOL
BKP less cement leakage and better reduction.

(11) Alvarez et al. 2006 [13] (1) VP (101) versus NSM (27)  
(2) Fractures >6 w and <1 y
(3) Postop, 3 mo,6 mo,1 y
VAS score (0–10)
VP superior to NSM up to 6 mo
ODI
VP superior to NSM up to 3 mo
NSM superior to VP after 3 mo
SF36
VP superior to NSM at 3 mo VP equivalent to NSM after 3 mo
NRVP: 59.6% VP inferior to NSM ( ) VP is more effective than NSM in pain relief and function in the early postop period. No difference was observed after 6 months

(12) Diamond et al. 2006 [14] (1) VP (88) versus NSM (38)  
(2) Acute number
(3) Postop, 6 w,  6 mo,  1 y,  2 y
VAS score (0–25)
VP superior to NSM only in 6 w ( .004)
Barthel Index
VP superior to NSM only in 6 w ( .02)
NRNRNRVP equivalent to NSMVP is more effective than NSM in pain relief and function in the early postop period. No difference was observed after 6 months

(13) Bae et al. 2010 [29](1) BKP (20) versus VP (20)  
(2) Subacute and chronic number
(3) 1 mo, 3 mo, 1 y, 2 y
VAS score
BKP equivalent to VP ( )
ODI
BKP equivalent to VP ( )
SF-12
BKP equivalent to VP ( )
NRBKP equivalent to VPBKP equivalent to VPBoth BKP and VP were equally effective in improving pain and disability/QOL

(14) Movrin et al. 2010 [33](1) BKP (46) versus VP (27)  
(2) Acute and subacute number
(3) Postop, 1 y
VAS score
BKP equivalent to VP
NRNRBKP superior to VP ( ). BKP equivalent to VPBKP equivalent to VPBoth BKP and VP were equally effective in improving pain and have low incidence of new VCFs. BKP is superior in kyphosis correction

(15) Kumar et al.2010 [42](1) BKP (24) versus VP (28)  
(2) Subacute number
(3) 1 w, 3 mo, 10 mo
VAS score
BKP superior to VP
ODI
BKP superior to VP ( )
SF-36/EQ-5D
BKP superior to VP
BKP superior to VPBKP equivalent to VPBKP equivalent to VPBoth BKP and VP were equally effective in improving pain, disability, and QOL; BKP yielded superior results maintained until last follow-up

(16) Eidt-Koch and Greiner 2011 [23](1) BKP versus NSM
(2) 82 pts
RMD
BKP superior to NSM
EQ-5D
BKP superior to NSM
BKP patients improve more than for NSM QoL

(17) Li et al. 2011 [39](1) BKP versus VP (96 pts)  
(2) Acute number
(3) 12 mo
VAS score
BKP equivalent to VP
BKP equivalent to VPBKP superior to VP9% BKP
35% VP
3 in BKP,
2 in VP
similar good outcomes.
BKP better kyphosis correction and less cement leak

(18) Bornemann et al. 2012 [24]NSM For 6 w and then BKP or NSMVAS score
BKP superior to NSM
BKP superior to NSMBKP was clearly better than NSM and should be offered much sooner

(19) Movrin 2012 [25](1) BKP (46) versus NSM (61)  
(2) Acute number
VAS score
BKP superior to NSM
BKP superior to NSMBKP (6.5%) superior to NSM  (16.4%)BK superior to NSM for pain control kyphosis reduction and adjacent number

(20) Omidi-Kashani et al. 2013 [40](1) BKP (29) versus VP (28)  
(2) Acute/subacute number
VAS score
BKP equivalent to VP
SF-36
BKP equivalent to VP
BKP equivalent to VPBKP equivalent to VPVP is preferred due to cost and equivalent results

(21) Lee et al. 2012 [28](1) BKP (82) versus NSM (149)  
(2) Acute/subacute number.
 (3) 1 mo, 3 mo, 6 mo, 1 y
VAS score
BKP superior to NSM only in 1st mo and then equivalent
ODI
BKP superior to NSM only in 1st mo and then equivalent
8 in NSM, 5 in KPPrompt BKP should not be indicated if no risk factors exist (age, BMD, BMI, collapse)