Interventional Neuroradiology Unit, Department of Diagnostic Imaging, Monash Medical Center, Melbourne, Australia.
Pain Physician. 2013 Jul-Aug;16(4):309-20.
Although over 300 articles have been published annually on vertebral augmentation in the last 5 years, there remains much debate about a fundamental question - is vertebral augmentation a safe and effective treatment to achieve analgesia, reduce disability, and improve quality of life in patients with a vertebral fracture? In this modern era of evidence-based clinical practice and public health care policy and funding, an evidentiary basis is needed to continue to perform vertebral augmentation. The aim of this narrative review is to summarize the latest and highest quality evidence for efficacy, safety, cost effectiveness, and potential survival benefit after vertebroplasty and kyphoplasty. The design, major inclusion criteria, primary outcome measures, relevant primary baseline characteristics, primary outcomes, relevant secondary outcomes, and limitations of prospective multicenter randomized sham-controlled and conservative management-controlled trials are summarized. Recently published meta-analyses or systematic reviews of efficacy that include these recent prospective studies of vertebral augmentation are examined. The highest quality procedural safety data relating to medical complications, cement leaks, and subsequent vertebral fracture are reviewed. Publications from national databases analyzing potential reduction in length of hospital stay and reduction in mortality after vertebral augmentation are presented. Finally, emerging literature assessing the potential cost-effectiveness of vertebral augmentation is considered. This narrative review will provide interventional pain physicians a summary of the latest and highest quality data published on vertebral augmentation. This will allow integration of the best available evidence with clinical expertise and patient wishes to make the most appropriate evidence-based clinical decisions for patients with symptomatic vertebral fracture.
尽管在过去的 5 年中，每年有超过 300 篇关于椎体增强的文章发表，但仍有一个基本问题存在争议——椎体增强治疗是否安全有效，可以实现镇痛、减少残疾和改善椎体骨折患者的生活质量？在这个基于证据的临床实践和公共卫生保健政策和资金的现代时代，需要有证据基础来继续进行椎体增强治疗。本叙述性综述的目的是总结经皮椎体成形术和后凸成形术的最新和最高质量的疗效、安全性、成本效益和潜在生存获益证据。总结了前瞻性多中心随机假手术对照和保守治疗对照试验的设计、主要纳入标准、主要结局指标、相关基线特征、主要结局、相关次要结局以及局限性。还检查了最近发表的关于疗效的荟萃分析或系统评价，其中包括这些最近的椎体增强前瞻性研究。审查了与医疗并发症、水泥渗漏和随后的椎体骨折相关的最高质量的程序安全性数据。介绍了分析椎体增强后住院时间缩短和死亡率降低的国家数据库出版物。最后，考虑了评估椎体增强潜在成本效益的新文献。本叙述性综述将为介入性疼痛医师提供关于椎体增强的最新和最高质量数据的摘要。这将使最佳可用证据与临床专业知识和患者意愿相结合，为有症状性椎体骨折的患者做出最适当的基于证据的临床决策。
