Vertebroplasty and Kyphoplasty for Metastatic Spinal Lesions: A Systematic Review.

Mohsen Sadeghi-Naini, Shahram Aarabi, Farhad Shokraneh, Leila Janani, Alexander R Vaccaro, Vafa Rahimi-Movaghar

Journal: Clinical spine surgery 2019;31(5):203-210

PMID: 29283901

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Abstract

INTRODUCTION

The spine is the most common site of bone metastases. Vertebroplasty (VP) and kyphoplasty (KP) have been proposed as potential minimally invasive therapeutic options for metastatic spinal lesion (MSL) pain. However, the efficacy of VP and KP on MSL pain is currently unclear.

OBJECTIVE

The aim of this study was to assess the effects of VP and KP compared with each other, usual care, or other treatments on pain, disability, and quality of life following MSL.

METHODS

We included randomized controlled trials and prospective nonrandomized controlled clinical trials assessing VP or KP for the treatment of pain following MSL without cord compression. We searched MEDLINE, EMBASE, PubMed, and CENTRAL.

RESULTS

The literature search revealed 387 citations. Of these, 9 trials met all eligibility criteria and were included in the qualitative analysis. In total, there were 622 patients enrolled in the trials and of them 432 were in the surgical treatment group (92 received KP, 97 received VP, 134 received VP and chemotherapy, 68 received VP and radiotherapy, and 41 received Kiva implant) and 190 were in the nonsurgical treatment group (83 received chemotherapy, 46 received radiotherapy, and 61 received other treatment). Using the grading of recommendations assessment, development and evaluation approach, pain (low-quality evidence) and functional scores (very low-quality evidence) improved more with VP plus chemotherapy than with chemotherapy alone (pain: mean difference, -3.01; 95% confidence interval, -3.21 to -2.80; functional score: mean difference, 15.46; 95% confidence interval, 13.58-17.34). KP seemed to lead to significantly greater improvement in pain, disability, and health-related quality of life (HRQoL) compared with nonsurgical management. VP plus Iodine-125 seemed to lead to significantly greater improvement in pain and disability in comparison with VP alone. VP plus radiochemotherapy resulted in better pain relief and HRQoL postoperatively in comparison with routine radiochemotherapy. There was low-quality evidence to prove that surgical treatment significantly decreases pain, and improves functional score and HRQoL following MSL in comparison with nonsurgical management.

CONCLUSION

On the basis of the analysis of currently published trial data, it is unclear whether VP for MSL provides benefits over KP.

LEVEL OF EVIDENCE

Level 2.

Address: Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences.; Neurosurgery Department, Emam Hossein Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran.; Department of Surgery, Trauma and Vascular Surgery, University of Washington, Seattle, WA.; Cochrane Schizophrenia Group, The Institute of Mental Health, the University of Nottingham and Nottinghamshire Healthcare NHS Trust, Nottingham, UK.; Department of Biostatistics, School of Public Health, Iran University of Medical Sciences.; Clinical Trial Center (CTC), Tehran University of Medical Science, Tehran, Iran.; Department of Orthopaedics and Neurosurgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA.; Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences.

DOI: 10.1097/BSD.0000000000000601