Percutaneous vertebroplasty versus conservative treatment for osteoporotic vertebral compression fractures: An updated meta-analysis of prospective randomized controlled trials.

BACKGROUND: This meta-analysis of Randomized Controlled Trials (RCTs) aims to evaluate the efficacy and safety in percutaneous vertebroplasty (PVP) and conservative treatment (CT) for osteoporotic vertebral compression fractures (OVCFs).

METHODS: The authors searched RCTs in electronic databases (Cochrane Central Register of Controlled Trials, PubMed, EMBASE, Medline, Embase, Springer Link, Web of Knowledge, OVID and Google Scholar) in a timeframe from their establishment to Feb 2017. We also manually searched the reference lists of reports and reviews for possible relevant studies. Researches on PVP versus CT in OVCFs were selected in this meta-analysis. The quality of all studies was assessed and effective data were pooled for this meta-analysis. The outcomes were measured by pain relief (one week, one month, three months and six months), quality of life (RDQ, ED-5Q and QUALEFFO) and the rate of adjacent vertebral fracture. Publication bias assessment was also performed, respectively. The meta-analysis was performed using RevMan 5.1.

RESULTS: 13 reports (12 RCTs) with a total 1231 patients (623 in the PVP and 608 in the CT) met inclusion criteria. Patients were followed up for at least 2 weeks in all the studies. Statistical differences were found between pain relief (one week (MD 1.36, 95% CI (0.55, 2.17)), one month (MD 1.56, 95% CI (0.43, 2.70)) and six months (MD -1.59, 95% CI (-2.9, -0.27))) and QUALEFFO (MD -5.03 95%CI (-7.94, -2.12)). No statistical differences were found between pain relief (three months (MD -0.28, 95% CI (-1.46, 0.90))), RDQ (MD -0.59, 95% CI (-1.31, 0.13)), ED-5Q (MD 0.10, 95% CI (-0.01, 0.22)) and the rate of adjacent vertebral fracture (RR 1.21, 95% CI (0.89, 1.62)).

CONCLUSIONS: PVP is associated with higher pain relief than CT in the early period. Furthermore, PVP did not increase the rate of adjacent vertebral fracture. The results indicate that it is a safe and effective treatment for OVCFs. Because of some limitations, these findings should be interpreted with caution. Additional studies are needed. Large, definitive RCTs are needed.