Kyphoplasty versus vertebroplasty for painful osteoporotic vertebral compression fractures—which one is better? A systematic review and meta-analysis

BACKGROUND Whether kyphoplasty or vertebroplasty is better for painful osteoporotic vertebral compression fracture is a widely debated issue. Studies on the comparison of the 2 approaches are relative limited and a wide variation exists in the patient population, study design, and results. These factors make it difficult for workers in this field to know the exact value of the 2 approaches. OBJECTIVE To perform a systematic review and meta-analysis to compare the clinical outcomes and complications of kyphoplasty versus vertebroplasty for painful osteoporotic vertebral compression fractures (OVCF). STUDY DESIGN A systematic review and meta-analysis. METHODS MEDLINE, EMBASE, and other databases were searched for all the relevant original articles published from January 1987 to September 2012 comparing kyphoplasty with vertebroplasty for painful OVCF. The following outcomes were mainly evaluated: visual analog scale (VAS), vertebral height, kyphosis angle, new vertebral fractures, and cement leakage. RESULTS A total of 15 articles fulfilled all the inclusion criteria. The baseline characteristics such as sex, age, and number of prevalent fractures were comparable for both groups (P > .05). VAS score for the kyphoplasty group was significantly more than that for the vertebroplasty group at 1-3 days, 3 months, 6 months, 1 year, and 2 years after surgery (P < .05). Vertebral height in the kyphoplasty group was significantly higher than the vertebroplasty group at 3 months, 6 months, and 2 years (P < 0.05). Kyphosis angle in the kyphoplasty group was significantly lower at 3 months, 6 months, and 2 years (P < 0.05). The occurrence of new vertebral fractures in the kyphoplasty group had no significant difference with the vertebroplasty group at 3 months, 6 months, and 2 years (P > 0.05). The occurrence of cement leakage was significantly lower in the vertebroplasty group (P < 0.05). LIMITATIONS The main limitations of this review are that the demographics and comorbidities of study participants were not reported. These possible sources of heterogeneity could not be examined. CONCLUSIONS Percutaneous kyphoplasty is better than vertebroplasty in the treatment of painful OVCF. Kyphoplasty had better improvement at VAS score, vertebral height, and kyphosis angle with lower occurrence of cement leakage.