Encalada Sebastian, Hunt Christine, Duszynski Belinda, Salmasi Vafi, Scholten Paul, Zhao Zirong, Rappard George, Rivers William Evan, Vu To-Nhu, Lobel Steven, Popescu Adrian, Prokop Larry J, Kreiner D Scott
Department of Pain Medicine, Mayo Clinic, Jacksonville, FL, USA.
International Pain and Spine Intervention Society, Hinsdale, IL, USA.
Interv Pain Med. 2025 Mar 15;4(1):100569. doi: 10.1016/j.inpm.2025.100569. eCollection 2025 Mar.
Osteoporotic vertebral compression fractures (OVCFs) are a common and often debilitating condition that significantly impacts quality of life and healthcare costs. While conservative treatment is often pursued initially after fracture, some patients experience severe pain refractory to conservative treatment. In these cases, minimally invasive vertebral augmentation procedures like balloon kyphoplasty (BKP) offer an alternative, but the benefits of BKP compared to conservative treatment remain unclear.
To evaluate the effectiveness of BKP versus conservative treatment for pain, quality of life, and function in patients with painful OVCFs.
Pain improvement up to 12 months after BKP.
Functional improvement, adverse events, and vertebral body height restoration.
This analysis included randomized controlled trials and prospective comparative studies in which at least 100 participants reported pain outcomes following BKP for OVCFs. The risk of bias was assessed using standard tools, and the certainty of the evidence was evaluated using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach.
BKP demonstrated superior pain reduction versus conservative treatment at 1 month (mean difference (MD): 2.32 [-3.65;-0.99], P < 0.001), 3 months (MD: 1.19 [-2.14; -0.24], P = 0.014), 6 months (MD: 1.34 [-2.65; -0.04], P = 0.044), and 12 months (MD: 1.11 [-1.96;-0.26], P = 0.029), with the largest effect observed at 1 month. Disability improvements were significant at 1 month (standardized mean difference (SMD): 1.08 [-1.67; -0.48], P < 0.001) and 3 months (SMD: 0.50 [-0.96; -0.04], P = 0.032), but not at 6 or 12 months. No significant differences were found in the risk for new vertebral compression fractures between both groups (odds ratio (OR): 1.36 [0.51; 3.64], P = 0.54). According to the GRADE system, moderate certainty evidence indicates that BKP provides superior pain relief compared to conservative treatment at all time points from 1 to 12 months.
BKP showed superior pain reduction compared to conservative treatment from 1 to 12 months and improved disability at 1 and 3 months, with moderate certainty evidence.
骨质疏松性椎体压缩骨折（OVCFs）是一种常见且往往使人衰弱的病症，会显著影响生活质量和医疗成本。虽然骨折后最初通常采用保守治疗，但一些患者经历了对保守治疗难治的严重疼痛。在这些情况下，像球囊后凸成形术（BKP）这样的微创椎体强化手术提供了一种替代方法，但与保守治疗相比，BKP的益处仍不明确。
评估BKP与保守治疗对疼痛性OVCFs患者的疼痛、生活质量和功能的有效性。
BKP后长达12个月的疼痛改善情况。
功能改善、不良事件和椎体高度恢复。
该分析纳入了随机对照试验和前瞻性比较研究，其中至少100名参与者报告了BKP治疗OVCFs后的疼痛结局。使用标准工具评估偏倚风险，并使用推荐分级、评估、制定和评价（GRADE）方法评估证据的确定性。
与保守治疗相比，BKP在1个月（平均差值（MD）：2.32[-3.65；-0.99]，P<0.001）、3个月（MD：1.19[-2.14；-0.24]，P = 0.014）、6个月（MD：1.34[-2.65；-0.04]，P = 0.044）和12个月（MD：1.11[-1.96；-0.26]，P = 0.029）时显示出更显著的疼痛减轻，在1个月时观察到最大效果。残疾改善在1个月（标准化平均差值（SMD）：1.08[-1.67；-0.48]，P<0.001）和3个月（SMD：0.50[-0.96；-0.04]，P = 0.032）时显著，但在6个月或12个月时不显著。两组之间新椎体压缩骨折的风险没有显著差异（比值比（OR）：1.36[0.51；3.64]，P = 0.54）。根据GRADE系统，中等确定性证据表明，与保守治疗相比，BKP在1至12个月的所有时间点都能提供更好的疼痛缓解。
有中等确定性证据表明，与保守治疗相比，BKP在1至12个月时显示出更显著的疼痛减轻，在1个月和3个月时改善了残疾情况。
