• Jintao Liu, Xiaofeng Li, Dezhi Tang, Xuejun Cui, Xiachun Li, Min Yao, Penfei Yu, Xiang Qian, Yongjun Wang, and Hong Jiang.
• Department of Orthopedic Surgery, Suzhou Hospital of Traditional Chinese Medicine, Suzhou, China Institute of Spine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
• Pain Physician. 2013 Sep 1;16(5):455-64.

BackgroundOsteoporotic vertebral compression fractures (OVCFs) are the most common osteoporotic fractures. Pain is the main symptom. Percutaneous vertebroplasty (PVP) is a therapeutic procedure performed to reduce pain in vertebral compression fractures. Numerous case series and several small, non-blinded, non-randomized controlled studies have suggested that vertebroplasty is an effective means of relieving pain from osteoporotic fractures. However, a recent pooled analysis from 2 multicenter randomized controlled trials concluded that the improvement in pain afforded by PVP was similar to placebo.ObjectiveTo compare the amount of pain reduction measured using the visual analog scale when OVCF is treated with vertebroplasty or conservatively, and assess the clinical utility of PVP.DesignA meta-analysis and systematic review of randomized controlled trials was performed comparing pain reduction following vertebroplasty and conservative treatment.LimitationsThere were few data sources from which to extract abstracted data or published studies. There were only 5 randomized controlled trials that met our criteria. The conservative treatments used as comparators in these trials were different.MethodsA search of MEDLINE from January 1980 to July 2012 using PubMed, the Cochrane Database of Systematic Reviews and Controlled Trials, CINAHL, and EMBASE. Relevant reports were examined by 2 independent reviewers and the references from these reports were searched for additional trials, using the criteria established in the QUOROM statement.ResultsPooled results from 5 randomized controlled trials are shown. There was no difference in pain relief in the PVP group at 2 weeks and one month when compared with the conservatively managed group. Pain relief in the PVP group was greater than that of the conservative group at 3 months, 6 months, and 12 months. However, after subgroup analysis, pain scores were similar between the PVP group and the sham injection group from 2 weeks to 6 months. Compared with non-operative therapy, PVP reduced pain at all times studied.ConclusionPVP has some value for relieving pain; however, the possibility of a placebo effect should be considered. PVP has gained acceptance as a complementary treatment when conservative management has failed before its benefits have been fully understood. More large scale, double blinded, controlled trials are necessary in order to quantify the pain relief afforded by PVP more precisely.

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