Sadeghi-Naini Mohsen, Aarabi Shahram, Shokraneh Farhad, Janani Leila, Vaccaro Alexander R, Rahimi-Movaghar Vafa
Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences.
Neurosurgery Department, Emam Hossein Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran.
Clin Spine Surg. 2018 Jun;31(5):203-210. doi: 10.1097/BSD.0000000000000601.
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.
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.
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.
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.
On the basis of the analysis of currently published trial data, it is unclear whether VP for MSL provides benefits over KP.
Level 2.
脊柱是骨转移最常见的部位。椎体成形术（VP）和后凸成形术（KP）已被提议作为转移性脊柱病变（MSL）疼痛的潜在微创治疗选择。然而，VP和KP对MSL疼痛的疗效目前尚不清楚。
本研究旨在评估VP和KP相互比较、与常规治疗或其他治疗相比，对MSL后疼痛、残疾和生活质量的影响。
我们纳入了评估VP或KP治疗无脊髓压迫的MSL后疼痛的随机对照试验和前瞻性非随机对照临床试验。我们检索了MEDLINE、EMBASE、PubMed和CENTRAL。
文献检索共获得387条引用。其中，9项试验符合所有纳入标准并纳入定性分析。试验共纳入622例患者，其中432例在手术治疗组（92例接受KP，97例接受VP，134例接受VP加化疗，68例接受VP加放疗，41例接受Kiva植入），190例在非手术治疗组（83例接受化疗，46例接受放疗，61例接受其他治疗）。采用推荐分级评估、制定和评价方法，与单纯化疗相比，VP加化疗在疼痛（低质量证据）和功能评分（极低质量证据）方面改善更明显（疼痛：平均差值，-3.01；95%置信区间，-3.21至-2.80；功能评分：平均差值，15.46；95%置信区间，13.58 - 17.34）。与非手术治疗相比，KP似乎能使疼痛、残疾和健康相关生活质量（HRQoL）有更显著的改善。与单纯VP相比，VP加碘-125似乎能使疼痛和残疾有更显著的改善。与常规放化疗相比，VP加放化疗术后疼痛缓解和HRQoL更好。低质量证据表明，与非手术治疗相比，手术治疗能显著减轻MSL后的疼痛，改善功能评分和HRQoL。
基于对目前已发表试验数据的分析，尚不清楚MSL的VP治疗是否比KP更具优势。
2级。
