Comparing Pain Reduction Following Kyphoplasty and Vertebroplasty for Osteoporotic Vertebral Compression Fractures

Abstract

Background: Osteoporosis with subsequent osteoporotic vertebral compression fractures is an increasingly important disease due not only to its significant economic impact but also to the increasing age of our population. Pain reduction and stabilization are of primary importance with osteoporotic vertebral compression fractures. Although many patients heal with conservative treatment consisting of rest or activity modification, analgesics, and bracing, the management of severe pain compels some patients to seek surgical intervention via 2 procedures: vertebroplasty and kyphoplasty. Although there is abundant support in the literature for both procedures, there remains debate over which procedure can most successfully reduce patients’ perception of pain. Objective: To determine the amount of pain reduction using the visual analog scale (VAS) with kyphoplasty and vertebroplasty in the treatment of osteoporotic vertebral compression fractures. Design: Meta-analysis Methods: A systematic review and meta-analysis of the available literature was performed to quantify the amount of pain reduction using the visual analog scale (VAS) between vertebroplasty and kyphoplasty for osteoporotic vertebral compression fractures. Results: Twenty-one studies, 14 vertebroplasty and 7 kyphoplasty, qualified for inclusion representing totals of 1,046 vertebroplasty and 263 kyphoplasty patients treated, respectively. Kyphoplasty and vertebroplasty resulted in a more than 5 point drop in the VAS in the immediate postoperative period (p<0.00001). Between the two, the difference in early pain relief was not significant. At final follow-up, the long-term VAS was improved for both procedures, but the final follow-up VAS for vertebroplasty and kyphoplasty was not significant when compared to the initial postoperative VAS (p=0.25, p=0.38, respectively). Conclusions: The analysis demonstrates that both procedures reduce the amount of pain in the immediate postoperative period by approximately 50%. Both procedures reduce pain in symptomatic osteoporotic vertebral compression fractures that have failed conservative treatment. Randomized controlled trials are needed to provide definitive data on which procedure is the most effective for vertebral compression fractures. Key words: vertebroplasty, kyphoplasty, vertebral compression fracture, osteoporosis