Vertebroplasty and kyphoplasty—evidence-based methods?

Open Access-This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the source is credited. One of the most common fragility fracture and a fracture associated with increased morbidity and mortality is the vertebral compression fracture (Hasserius et al. 2005). The incidence varies, being higher in Scandinavian, American, and Hong Kong Chinese females than in eastern European females. In contrast, the incidence in male Hong Kong Chinese and Amer-ican Caucasians is lower than in male Europeans (Melton et al. 1993, Lau et al. 1996, O'Neill et al. 1996). The female-to-male ratio in Caucasians is 2:1, with an age-dependent increase in both men and women, giving an incidence of 20 per 10 5 person-years in individuals below 45 years of age and 1,200 per 10 5 person-years in those aged 85 years and above (O'Neill et al. 1996). In light of the enormous costs and the negative health aspects associated with vertebral fractures, percutaneous ver-tebroplasty and kyphoplasty were introduced. Vertebroplasty by percutaneous injection of bone cement was originally developed in France, and in 1987 it was first reported as one strategy for stabilizing vertebral bodies affected by a tumor (Galibert et al. 1987). In 1989, the method was also shown to stabilize fractured osteoporotic vertebrae (Lapras et al. 1989). Vertebroplasty was hypothetically improved by introduction of the percutaneous balloon kyphoplasty technique (Lieberman et al. 2001). This involves inflating a balloon in the fractured vertebral body in order to restore the anatomy of the fractured vertebra and reduce the fracture-induced kypho-sis. The void created is then filled with bone cement. Both methods immediately attracted a great amount of interest. A Medline search in Oct 2004 identified 388 articles on " verte-broplasty " and 92 on " kyphoplasty ". A similar search in Jan 2010 resulted in 1,398 hits for " vertebroplasty " and 1,573 for " kyphoplasty ". The two techniques, the short-term clinical results, and the possible complications have all been thoroughly reported (Lieberman et al. 2001, Diamond et al. 2003), but up until now there have been no prospective randomized controlled trials (RCTs) published regarding the efficacy of the procedures. Case reports, prospective and retrospective uncontrolled short-term observational studies, and case-control studies have consistently inferred an almost immediate relief of back pain and improved functional status after such procedures in 75–90% of cases (Lieberman …