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Meta-Analysis Of Vertebroplasty Versus Kyphoplasty 2007

Interventional Spine

Jason C Eck, DO, MS
Dean Nachtigall, DO, Non ASSR Member
S. Craig Humphreys, MD, Non ASSR Member
Scott D Hodges, DO, Non ASSR Member

Scientific Paper

Purpose

Previous investigators have reported on benefits and risks associated with vertebroplasty and kyphoplasty, but there is limited comparison data. Additionally, much of the data is from retrospective studies and case series. The purpose of this study was to review the literature and perform a meta-analysis of pain relief and complications associated with these procedures.

Methods & Materials

A comprehensive review of the literature was performed. Abstracts were reviewed, and studies containing information on pain relief or complications following vertebroplasty or kyphoplasty were obtained. Preoperative, postoperative and change in visual analog pain scale (VAS) were tabulated. Complications related to vertebroplasty or kyphoplasty were identified. Data were analyzed using paired t-tests to determine if significant differences existed for the combined population in VAS following vertebroplasty or kyphoplasty. The change in VAS was compared using standard t-tests to determine if significant differences existed in degree of postoperative change between vertebroplasty versus kyphoplasty. Studies reporting associated complications were identified and complications were tabulated along with the total number of procedures and patients to obtain overall rates of each complication. Chi-squared analysis identified any significant differences in complications.

Results

A total of 1036 abstracts were identified. Of these, 168 studies meet inclusion criteria. Mean pre and postoperative VAS for vertebroplasty were 8.36 and 2.68, respectively, with mean change of 5.68 (p<0.001). Mean pre and postoperative VAS for kyphoplasty were 8.06 and 3.46, respectively, with mean change of 4.60 (p<0.001). Risk of new fracture was 17.9% with vertebroplasty versus 14.1% with kyphoplasty (p<0.01). Risk of cement leak was 19.7% with vertebroplasty versus 7.0% with kyphoplasty (p<0.001).

Conclusion

Both vertebroplasty and kyphoplasty provided significant improvement in pain. Vertebroplasty had a significantly greater improvement in pain scores but also had statistically greater risk of cement leakage and new fracture, with a trend toward increased risk of pulmonary embolism.