Kyphoplasty superior to vertebroplasty for osteoporotic vertebral compression fractures .
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(13):23 J Clin Neurosci. 2013 Jun;20(6):795-803. doi: 10.1016/j.jocn.2012.05.038. Epub 2013 Feb 18.10 trials (783 patients) were analyzed in this meta-analysis to compare the safety and efficacy between balloon kyphoplasty (KP) and percutaneous vertebroplasty (VP) in the treatment of osteoporotic vertebral compression fractures (OVCF). The meta-analysis found that balloon kyphoplasty had significantly better long term results (longer than 6 months) in terms of kyphosis angle, anterior height of the vertebral body, and cement leakage rates. No between-group differences were found in short and long term visual analog scale (VAS) pain and Oswestry-Disability Index scores, operative times, short term kyphosis angle, or adjacent-level fracture rates.
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Incierto = 0,5
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Introduction
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Accessing Data
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Analysing Data
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Results
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Discussion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
El Índice de Fragilidad es una herramienta que ayuda en la interpretación de hallazgos significativos, proporcionando una medida de fuerza para un resultado. El Índice de Fragilidad representa el número de eventos consecutivos que es necesario añadir a un resultado dicotómico para que el hallazgo deje de ser significativo. Un número pequeño representa un hallazgo más débil y un número grande un hallazgo más fuerte.
¿Por qué se necesitaba ahora este estudio?
Worldwide, osteoporotic vertebral compression fractures (OVCF) have detrimental effects on patients. They are responsible for decrease in anterior vertebral height, spinal deformity, reduced pulmonary function, abdominal and thoracic content restriction, impaired mobility, and depression. Two surgical procedures, vertebroplasty (VP) and kyphoplasty (KP), have demonstrated better pain relief, vertebral restoration, and mobility than conservative treatments. A previous study stated that kyphoplasty, however, had higher costs than vertebroplasty. Hence, a meta-analysis was needed to compare both surgical procedures with each other.
¿Cuál era la pregunta principal de la investigación?
What is the safety and efficacy of balloon kyphoplasty (KP) compared to percutaneous vertebroplasty (VP) in treatment of osteoporotic vertebral compression fractures (OVCF)?
- In 7 trials, reporting short term VAS no difference was found between KP and VP (MD= -0.57, 95% CI= -1.33 to 0.20; p=0.15). Similar results were seen in long term VAS scores in 9 studies (MD = -0.99, 95% CI = -2.29 to 0.31; p=0.14).
- In 5 studies, covering ODI scores, 2 showed no differences between the groups in short term results (MD= -6.54, 95% CI = -14.57 to 1.48; p=0.11) and 5 had no differences in long term results (MD= -2.01, 95% CI -11.75 to 7.73; p = 0.69).
- 2 trials indicated no differences in operative times between KP and VP (MD = 4.47, 95% CI = -0.22 to 9.17; p=0.06).
- 3 studies found no differences in short term kyphosis angle after operation (MD= -2.25, 95% CI= -5.14 to 0.65; p=0.13). However, in 4 trials, the long term kyphosis angle was better with KP (MD=-2.64, 95% CI = -4.66 to -0.61; p=0.01).
- 4 trials reported better anterior height restoration of the vertebral body in KP (MD= 3.67, 95% CI =1.40 to 5.94; p =0.002).
- 9 studies also suggested a lower cement leakage rate in KP (RR=0.70, 95% CI =0.52 to 0.95; p=0.02).
- In 7 trials, no differences were seen between two procedures in adjacent vertebral compression fractures (RR=1.52, 95% CI = 0.76 to 3.03; p = 0.24).
¿Qué es lo que más debo recordar?
The analyzed data suggested that kyphoplasty and vertebroplasty had similar operative time, pain relief, and functional scores in the treatment of osteoporotic vertebral compression fractures. However, kyphoplasty resulted in better long term kyphosis angle, restoration of vertebral body height, and lower risk of cement leakage.
¿Cómo afectará esto al cuidado de mis pacientes?
Although the study supports the use of kyphoplasty for better kyphosis angle, vertebral height restoration, and lower risk of cement leakages, the methodological quality and risk of bias of the studies was poor. Further trials still need to be conducted on this topic.
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