Authors' objectives:

This review aims to assess the available evidence on vertebroplasty and balloon-assisted vertebroplasty for the treatment of osteoporotic compression fractures.

Authors' recommendations: With regard to vertebroplasty and balloon-assisted vertebroplasty for osteoporotic compression fractures, the ICSI Technology Assessment Committee finds: Vertebroplasty should be offered only to carefully selected patients whose pain is not controlled by conservative management (typically when severe pain has persisted for more than 10 to 12 weeks). In 8 of the 10 studies cited, significant decreases in mean visual analog scale (VAS) pain scores were reported after treatment. In the 6 studies that reported individual responses, 84% to 100% of patients reported partial or complete pain relief. Of 5 studies that assessed medication use, 4 reported decreased use. Three of 5 studies that assessed mobility found improved mobility. However, 3 of the 10 studies cited relied on a retrospective assessment of pain and in all studies it was unclear if an adequate trial of conservative management was attempted. (Conclusion Grade III) Theoretically, balloon-assisted vertebroplasty is only appropriate for patients with immediate intractable pain yet the data are from studies that allowed a period of conservative management. All 3 of the studies cited reported decreased pain; 2 studies reported significant improvements based on either the SF-36 or VAS pain scores. There is insufficient evidence to conclude whether balloon-assisted vertebroplasty restores vertebral height or alignment and whether any such restoration, if it occurred, would affect medical complications associated with vertebral compression fractures. (Conclusion Grade Not Assignable) Although treatment in an acute care setting may have value, it has not been well studied. Both procedures are acceptably safe based on published reports of procedure-related complications. The potential for serious side effects (including pulmonary embolism in up to 4% and paraplegia or death in up to 1%) must be considered. More data are needed before further conclusions about safety, including the potential for an increased rate of fracture in vertebrae adjacent to treated vertebrae, can be reached. Evaluation of the causes of osteoporosis and treatment with appropriate referral and pharmacologic agents for osteoporosis, if not already done by the time of vertebroplasty or balloon-assisted vertebroplasty, is important in reducing the risk of future fractures. Both procedures should be performed in the context of controlled clinical trials. The evidence, to date, is from uncontrolled series with small sample sizes, subjective outcome measures, and limited follow-up.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.icsi.org/knowledge/detail.asp?catID=107&itemID=1355

Year Published: 2004

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Institute for Clinical Systems Improvement

Contact Address: 8009 34th Avenue South, Suite 1200, Bloomington, MN, USA. Tel: +1 952 814 7060; Fax: +1 952 858 9675

Contact Name: icsi.info@icsi.org

Contact Email: icsi.info@icsi.org

Copyright: Institute for Clinical Systems Improvement (ICSI)