Comparing Pain Reduction Following Vertebroplasty and Conservative Treatment for Osteoporotic Vertebral Compression Fractures: A Meta-Analysis of Randomized Controlled Trials

Background: Osteoporotic vertebral compression fractures (OVCFs) are the most commonosteoporotic fractures. Pain is the main symptom. Percutaneous vertebroplasty (PVP) is atherapeutic procedure performed to reduce pain in vertebral compression fractures. Numerouscase series and several small, non-blinded, non-randomized controlled studies have suggestedthat vertebroplasty is an effective means of relieving pain from osteoporotic fractures. However,a recent pooled analysis from 2 multicenter randomized controlled trials concluded that theimprovement in pain afforded by PVP was similar to placebo.Objective: To compare the amount of pain reduction measured using the visual analog scalewhen OVCF is treated with vertebroplasty or conservatively, and assess the clinical utility of PVP.Design: A meta-analysis and systematic review of randomized controlled trials was performedcomparing pain reduction following vertebroplasty and conservative treatment.Limitations: There were few data sources from which to extract abstracted data or publishedstudies. There were only 5 randomized controlled trials that met our criteria. The conservativetreatments used as comparators in these trials were different.Methods: A search of MEDLINE from January 1980 to July 2012 using PubMed, the CochraneDatabase of Systematic Reviews and Controlled Trials, CINAHL, and EMBASE. Relevant reportswere examined by 2 independent reviewers and the references from these reports were searchedfor additional trials, using the criteria established in the QUOROM statement.Results: Pooled results from 5 randomized controlled trials are shown. There was no differencein pain relief in the PVP group at 2 weeks and one month when compared with the conservativelymanaged group. Pain relief in the PVP group was greater than that of the conservative group at3 months, 6 months, and 12 months. However, after subgroup analysis, pain scores were similarbetween the PVP group and the sham injection group from 2 weeks to 6 months. Comparedwith non-operative therapy, PVP reduced pain at all times studied.Conclusion: PVP has some value for relieving pain; however, the possibility of a placeboeffect should be considered. PVP has gained acceptance as a complementary treatment whenconservative management has failed before its benefits have been fully understood. More largescale, double blinded, controlled trials are necessary in order to quantify the pain relief affordedby PVP more precisely.Key words: Vertebroplasty, osteoporosis, vertebral compression fracture, randomizedcontrolled trials, systemic review, meta-analysis