Percutaneous vertebroplasty vs. nonoperative treatment for osteoporotic vertebral fracture

Study Type: Therapy
OE Level of Evidence: 1
Journal Level of Evidence: N/A
Synopsis
Eleven randomized controlled trials (n=1048 patients) were included in this meta-analysis for the purpose of comparing percutaneous vertebroplasty (PVP) and conservative therapy treatment for patients with osteoporotic vertebral compression fractures (OVCFs). The primary outcome of interest was pain severity at three follow-up ranges: 1 to 2 weeks, 2 to 3 months, and at 1 year. Results demonstrated that Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Non-funded
Conflicts: Other
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Why was this study needed now?
Conservative treatments of osteoporotic vertebral compression fractures (OVCFs) includes bed rest, oral analgesia, muscle relaxants, bracing, and physical therapy; however, satisfactory response to conservative treatment is not met by all patients. Therefore, percutaneous vertebroplasty (PVP), which involves injection of bone cement or polymethylmethacrylate into the affected vertebral body, can be performed, and has been reported to be a safe and effective surgical procedure. There still remains some debate regarding the long-term efficacy of conservative treatment versus PVP.
What was the principal research question?
For patients with OVCFs, did treatment with percutaneous vertebroplasty result in significantly different pain outcome over 1-year follow-up when compared to conservative treatment?
Data Source: CENTRAL (Cochrane Central Register of Controlled Trials), MEDLINE, Embase, CINAHL, and Web of Science databases were searched for articles of potential inclusion published up to February 2015. The reference lists of included studies were also manually searched for any other additional articles of interest.
Index Terms: Index terms used included vertebroplasty, percutaneous, osteoporosis, randomize controlled trials and were combined with Boolean terms for search strategy. For full details regarding the search strategy of this meta-analysis and systematic review, please refer to the original full publication.
Study Selection: Eligibility criteria included: a randomized controlled trial design; enrolled patients with one or more osteoporotic vertebral compression fractures in the thoracic and/or lumbar spine; allocated patients to treatment with percutaneous vertebroplasty (either adjunct to other forms of treatment or alone), and to control intervention with nonoperative interventionas; and reported outcome related to pain. Screening and selection of relevant studies were performed by two independent investigators. Disagreements were resolved with consensus or by a third reviewer. A total of 11 RCTs were selected for final inclusion.
Data Extraction: Data extraction was performed by two independent reviewers using a standardized form. The minimal clinically important difference (MCID) in pain severity was determined by review of current literature; a difference of at least 1.5 points on a NRS or VAS pain scale was determined to be of clinical importance.
Data Synthesis: All analyses were performed with the Comprehensive Meta-Analysis (CMA) program (version 2.2.064) with a random effects model. Effect sizes were calculated for the following time periods: 1 to 2 weeks, 2 to 3 weeks, and at 12 months. Results were reported as mean differences (MD) with accompanying 95% confidence intervals; heterogeneity was assessed with I^2 statistic. Publication bias was assessed with the Egger test and funnel plot visualization.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.