Background: Percutaneous vertebroplasty (PVP) and percutaneous balloon kyphoplasty (PKP) can
increase bone strength as well as alleviate the pain caused by vertebral compression fractures (VCFs), and
both procedures rely on polymethyl methacrylate (PMMA) cement injected into the fractured vertebra for
mechanical stabilization of the VCFs. However, there is debate over which of these 2 surgical procedures
can give better short-term and long-term outcomes. A lot of studies and meta-analysis were designed to
assess the advantages and drawbacks of PKP and PVP in the treatment of VCFs, but most of them didn’t
consider the effect of VCF levels on the treatment outcome, which can influence the results.
Objective: To assess the safety and efficacy of PKP compared to PVP in the treatment of single level
osteoporotic vertebral compression fractures (OVCF).
Study Design: Studies with the following criteria were included: patients with VCFs due to osteoporosis;
PKP comparing PVP; study design, RCT or prospective or retrospective comparative studies. Furthermore,
the studies which reported at least one of the following outcomes: subjective pain perception, quality of
life evaluation, incidence of new adjacent vertebral fracture, bone cement leakage, and post-operative
kyphotic angle. Articles were excluded in our meta-analysis if they had a neoplastic etiology (i.e.,
metastasis or myeloma), infection, neural compression, traumatic fracture, neurological deficit, spinal
stenosis, severe degenerative diseases of the spine, previous surgery at the involved vertebral body, and
PKP or PVP with other invasive or semi-invasive intervention treatment.
Setting: University hospital.
Methods: A systematic search of all articles published through May 2014 was performed by Medline,
EMASE, OVID, and other databases. All the articles that compared PKP with PVP on single level OVCF
were identified. The evidence quality levels of the selected articles were evaluated by Grade system. Data
about the clinical outcomes and complications were extracted and analyzed.
Results: Eight studies, encompassing 845 patients, met the inclusion criteria. Overall, the results
indicated that there were significant differences between the 2 groups in the short-term visual analog
scale (VAS) scores, the long-term Oswestry Disability Index (ODI), short- and long-term kyphosis angle,
the kyphosis angle improvement, the injected cement, and the cement leakage rates. However, there
were no significant differences in the long-term VAS scores, the short-term ODI scores, the short- and
long-term SF-36 scores, or the adjacent-level fracture rates.
Limitations: Statistical efficacy can be improved by more studies, low evidence based non-RCT articles are
likely to induce various types of bias, no accurate definition of short-term and long-term outcome time points.
Conclusion: PKP and PVP are both safe and effective surgical procedures in treating OVCF. PKP has
a similar long-term pain relief, function outcome (short-term ODI scores, short-and long-term SF-36
scores), and new adjacent VCFs in comparison to PVP. PKP is superior to PVP for the injected cement
volume, the short-term pain relief, the improvement of short- and long-term kyphotic angle, and lower
cement leakage rate. However, PKP has a longer operation time and higher material cost than PVP. To
confirm this evaluation, a large multi-center randomized controlled trial (RCT) should be conducted.
Key words: Percutaneous, kyphoplasty, vertebroplasty, osteoporosis vertebral compression fracture,
pain, meta-analysis
Pain Physician 201
Long-term evaluation of pain reduction after vertebroplasty and kyphoplasty
