Percutaneous vertebroplasty for osteoporotic vertebral compression fracture

Area of Science:

• Orthopedics
• Neurosurgery
• Radiology

Background:

• Percutaneous vertebroplasty is a common treatment for osteoporotic vertebral fractures.
• Previous reviews suggest limited support for its routine use.

Purpose of the Study:

• To update evidence on the benefits and harms of vertebroplasty for osteoporotic vertebral fractures.
• To compare vertebroplasty against placebo, usual care, and other interventions.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs) and quasi-RCTs.
• Included trials comparing vertebroplasty with placebo (sham), usual care, or other interventions.
• Primary comparison was vertebroplasty versus placebo due to lower bias risk.

Main Results:

• High- to moderate-quality evidence shows vertebroplasty provides no clinically important benefits for pain, disability, or quality of life compared to placebo.
• Small, statistically significant improvements in pain and disability were observed but below minimal clinical importance.
• Low-quality evidence indicates uncertainty regarding increased risks of new symptomatic vertebral fractures and serious adverse events.

Conclusions:

• Vertebroplasty offers no important benefits for acute or subacute osteoporotic vertebral fractures compared to sham procedures.
• Sensitivity analyses suggest trials comparing vertebroplasty with usual care may overestimate benefits.
• Patients must be informed about the lack of proven benefits and potential risks associated with vertebroplasty.