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Title: Mortality Outcomes of Vertebral Augmentation (Vertebroplasty and/or Balloon Kyphoplasty) for Osteoporotic Vertebral Compression Fractures: A Systematic Review and Meta-Analysis.
Austin Authors: Hinde, Kenji;Maingard, Julian;Hirsch, Joshua A;Phan, Kevin;Asadi, Hamed ;Chandra, Ronil V
Affiliation: School of Medicine, Monash University, Melbourne, Australia
Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia
Interventional Neuroradiology Unit, Monash Imaging, Melbourne, Australia
Interventional Neuroradiology Service, Department of Radiology, Austin Health, Heidelberg, Victoria, AustraliaInterventional Radiology Service, Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
Department of Radiology, Western Health, Western Hospital, Footscray, Melbourne, Victoria 3011, Australia
School of Medicine-Faculty of Health, Deakin University, Warrun Ponds, Australia
Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
Issue Date: Apr-2020 2020-02-18
Publication information: Radiology 2020: 295(1): 96-103
Abstract: Background Osteoporotic vertebral compression fractures (OVCFs) are prevalent, with associated morbidity and mortality. Vertebral augmentation (VA), defined as either vertebroplasty and/or balloon kyphoplasty (BKP), is a minimally invasive surgical treatment to reduce pain and further collapse and/or renew vertebral body height by introducing bone cement into fractured vertebrae. Nonsurgical management (NSM) for OVCF carries inherent risks. Purpose To summarize the literature and perform a meta-analysis on the mortality outcomes of patients with OVCF treated with VA compared with those in patients treated with NSM. Materials and Methods A single researcher performed a systematic literature review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, or PRISMA, guidelines. Online scientific databases were searched in April 2018 for English-language publications. Included studies investigated mortality in patients with OVCF with VA as the primary intervention and NSM as the comparator. A meta-analysis was performed for studies that reported hazard ratios (HRs) and 95% confidence intervals (CIs). HR was used as a summary statistic and was random-effect-models tested. The χ2 test was used to study heterogeneity between trials, and the I2 statistic was calculated to estimate variation across studies. Results Of the 16 included studies, eight reported mortality benefits in VA, seven reported no mortality difference, and one reported mixed results. Seven studies were included in a meta-analysis examining findings in more than 2 million patients with OVCF (VA = 382 070, NSM = 1 707 874). The pooled HR comparing VA to NSM was 0.78 (95% CI: 0.66, 0.92; P = .003), with mortality benefits across 2- and 5-year periods (HR = 0.70, 95% CI: 0.69, 0.71, P < .001; and HR = 0.79, 95% CI: 0.62, 0.9999, P = .05; respectively). Balloon kyphoplasty provided mortality benefits over vertebroplasty, with HRs of 0.77 (95% CI: 0.77, 0.78; P < .001) and 0.87 (95% CI: 0.87, 0.88; P < .001), respectively. Conclusion In a meta-analysis of more than 2 million patients, those with osteoporotic vertebral compression fractures who underwent vertebral augmentation were 22% less likely to die at up to 10 years after treatment than those who received nonsurgical treatment. © RSNA, 2020 See also the editorial by Jennings in this issue.
DOI: 10.1148/radiol.2020191294
ORCID: 0000-0003-2979-6420
Journal: Radiology
PubMed URL: 32068503
Type: Journal Article
Appears in Collections:Journal articles

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