The Association between the Duration of Preoperative Pain and Pain Improvement in Vertebral Augmentation: A Meta-Analysis

A. Ehteshami Rad; M.T. Luetmer; M.H. Murad; D.F. Kallmes

doi:10.3174/ajnr.A2618

Abstract

BACKGROUND AND PURPOSE: Most physicians consider length of preoperative pain as an important factor to include patients for SA. Our aim was to synthesize the available evidence regarding the influence of preprocedural pain duration on the outcome of vertebral augmentation procedures.

MATERIALS AND METHODS: The MEDLINE data base was reviewed up to March 2010. Meta-regression and mixed-effect subgroup analyses were performed to evaluate the association between the outcome of interest, which was pain improvement assessed by a VAS (0–10) and the duration of preoperative pain (independent variable).

RESULTS: We included 17 articles. The mean VAS improvements for subgroups of ≤6 weeks (n = 12), 6–24 weeks (n = 5), and >24 weeks (n = 3) were 5.18, 4.90, and 5.04, respectively (P = .86). The regression coefficient was −0.024, suggesting trivial association of the duration of preoperative pain and pain improvement.

CONCLUSIONS: Pain relief following spine augmentation was similar among groups of patients with varying lengths of preoperative pain duration.

ABBREVIATIONS:

KP: kyphoplasty
NA: not applicable
SA: spine augmentation
VAS: visual analog scale
VP: vertebroplasty

Vertebral augmentation is widely applied for the treatment of painful vertebral compression fractures, both benign and malignant.^1–10 Specific clinical and imaging selection criteria include duration and pattern of subjective pain; imaging characteristics on plain film, MR imaging, and CT; and findings on physical examination. Among these selection criteria, duration of pain has garnered substantial interest. When initially applied, vertebral augmentation was reserved for patients who had failed at least 4–6 weeks of conservative therapy. This waiting period was recommended, given the knowledge that in most patients, spontaneous osteoporotic compression fractures will heal without intervention during several weeks.

With increasing clinical experience, the indications for vertebral augmentation have expanded to include patients with relatively acute fractures. Indeed, some practitioners suggest that these early fractures represent the ideal candidates for augmentation and that more chronic fractures are poor candidates for intervention.^11–14

Several studies evaluated the impact of pain duration on the observed outcome following vertebral augmentation.^15–17 Improved understanding of the impact of pain duration would help guide practitioners in selecting patients for augmentation. We conducted a systematic review and meta-analysis of the vertebral augmentation literature to synthesize the available evidence regarding the influence of preprocedural pain duration on the outcome of vertebral augmentation procedures.

Materials and Methods

A comprehensive review of the literature up to March 2010 was performed by 2 independent reviewers. “Vertebroplasty pain” and “kyphoplasty pain” were used as both controlled vocabulary and keywords to search MEDLINE by using the Ovid interface. The 2 reviewers discussed disagreements and reconciled their differences. The results were limited to case series, case-controlled studies, major clinical studies, clinical trials, and cohort studies. Inclusion criteria were the following: English language, >50 patients, numeric VAS assessment for pre- and postopertive pain, and availability of the mean age of fracture or preoperative pain duration. The exclusion criteria were the following: case reports, in vitro or cadaveric studies, guidelines and general discussions, and technical notes.

The electronic search was supplemented by asking experts in the field and reviewing the bibliographies of included studies for relevant publications. Abstracts, methods, results, figures, and tables of full text were searched for pain questions, pre- and postoperative numeric pain scales and preoperative pain duration, and/or vertebral fracture age at the time of vertebral augmentation. Preoperative pain duration and age of fracture were considered interchangeable, because few studies distinguished these. Pain improvement was calculated on the basis of the pre- and postprocedural VAS (0–10) at 24 hours. Unfortunately, additional follow-up time points were incompletely reported among the identified studies.

To explore the impact of the mean duration of pain before intervention among studies, we grouped studies according to the mean preoperative pain duration (≤6 weeks, 6–24 weeks, and >24 weeks) and compared pain improvement among these. We also evaluated the correlation between the age of fracture and pain improvement by using a VAS.

Studies that were not adjustable to any of the above categorizations were excluded. From comparative studies between vertebral augmentation and conservative therapy or placebo control, only augmentation arms were included. All original preoperative pain lengths were converted to weeks, and numeric pain scores other than 0–10^18–22 were converted to 0–10 scores.

Statistical Analysis

Statistical analysis was performed by using Comprehensive Meta-Analysis, Version 2 software (Biostat, Englewood, New Jersey). Continuous data, including mean pain improvement on the VAS, were pooled to calculate weighted mean differences with 95% confidence intervals. A random-effects model was used²³; subgroups were compared by using the Z-test. The null hypothesis was that the effect size was the same for all subgroups. I² was used to assess heterogeneity across studies.²⁴ The influence of sample size was assessed by funnel plots and the trim-and-fill method, and the presence of publication bias was assessed by the Egger regression test. A random-effects meta-regression was used to assess the preoperative pain duration covariate with pain improvement as a dependent variable. Publication bias was assessed by using the trim-and-fill model. We excluded 1 study²⁰ because preoperative pain was reported only as a range (<6 weeks) without a mean. SDs for 3 studies^9,25,26 were calculated through other formulas.²⁷ Sensitivity analysis was performed by excluding every single study from the analysis to assess the robustness of final assumptions and by conducting a cumulative meta-analysis to explore how pre- and postoperative mean pain differences varied with increasing preoperative pain duration.

Results

Between July 1985 and March, 2010, 768 articles were retrieved by using the term “vertebroplasty pain” and 878 articles were found by using the term “kyphoplasty pain.” Fig 1. details the study-selection processes and the reasons for exclusion. The final cohort included 17 studies^{1,9,19–21,25,26,28–37} described in Table 1. Among these included studies, 6 (35%) reported age of fracture,^{21,28,29,32,35,37} 13 (76%) described preoperative pain duration,^{1,9,19,20,25,26,28,30,31,33,34,36,37} and 2 (12%) stated both.^28,37

Fig 1.

Inclusion of the final 17 articles.

View this table:

Table 1:

Characteristics of included studies

There were 3 (18%) articles that compared vertebroplasty with kyphoplasty,^31,34,36 4 (24%) compared vertebroplasty with conservative therapy,^1,20,28,35 and 1 (6%) compared kyphoplasty with conservative therapy.³⁷ Six (35%)^{9,19,26,29,32,33} of 17 articles included exclusively vertebroplasty procedures, while 3 (18%) studies reported kyphoplasty procedures exclusively.^21,25,30 We included 1516 patients and 2010 treated levels through 20 treatment arms of 17 studies. The mean (±SD) number of patients and levels was 76 (43.8) and 106 (67.6), respectively, per study. The median follow-up was 12 months (range, 3–24 months).^21,33,35 The characteristics of each subgroup are shown in Table 2.

View this table:

Table 2:

Demographics of categories with various preoperative pain durations^{^a}

For the meta-analysis, the Q-statistic was 0.311 with df = 2 and P = .86 (Fig 2). Thus, we cannot reject the null hypothesis that the effect size is the same for all 3 groups (Table 3).

Fig 2.

The forest plot shows subgroup analysis.

View this table:

Table 3:

Details of meta-analysis under the random-effects model

With the random-effects model, the raw mean difference (pain improvement) for 19 studies was 5.10 VAS with a confidence interval of 4.70–5.50, which yields a Z value of 24.860 (2-tailed P < .001). Because of the weak correlation, the null hypothesis of no linear relation between the length of pain and pain improvement was rejected.

Within-group heterogeneity expressed by using the I² statistic was quite high: 92.61%, 93.81%, and 95.74% for studies with <6 weeks', 6–24 weeks', and >24 weeks' preoperative pain. The regression coefficient for preoperative pain duration was −0.024, which indicates that for each 1-week increase in the length of preoperative pain, the VAS in pain improvement decreased by 0.024 (Fig 3). The model and residual Q were 16.43 and 208.23, respectively. The clinical significance of this trivial correlation is unclear. There were 3 missing studies on the left of the mean in the funnel plot (Fig 4). Adjusted mean pain improvement was 4.9 (4.4–5.3) and Q = 510.9. The cumulative meta-analysis shows how increase in the age of fracture from the shortest preoperative pain duration³⁵ to the longest one³² shifts pain improvement among studies (Fig 5).

Fig 3.

The linear correlation between preoperative pain duration and pain improvement is shown.

Fig 4.

Publication bias among studies is shown.

Fig 5.

The cumulative meta-analysis shows the influence of increasing preoperative pain duration on the outcome of the study.

The impact of sample size is shown in cumulative meta-analysis from the biggest sample size study²⁹ to the smallest one (Fig 6).³⁵ The Egger regression test for publication bias was significant (P = .03), suggesting the presence of publication bias.

Fig 6.

The cumulative meta-analysis shows the influence of increasing sample size on the outcome of the study.

In sensitivity analysis, the final outcome did not depend on any single study result.

Discussion

We conducted a meta-analysis that showed that vertebral augmentation is associated with significant reduction in back pain. However, we did not find any significant difference in pain improvement among subgroups with different preoperative pain durations. There was also a weak negative correlation between the age of fracture and immediate pain improvement after vertebral augmentation. The clinical significance of this slight correlation remains unclear. Thus, it seems that the age of fracture does not affect the outcome of vertebral augmentation; therefore, a wider range of patients could be referred for the procedure.

One prior study has shown that early treatment was correlated with greater patient satisfaction with the outcome. Unfortunately, the metric of “satisfaction with care” is rarely reported in the spine-augmentation literature. Future studies should include this specific outcome.³⁸

Treatment of acute fractures might seem to be the ideal paradigm because pain in these fractures may be maximal. However, the few controlled studies currently available regarding acute fracture treatment have shown identical outcomes between patients treated with augmentation versus those treated conservatively.^20,35 The noted similar improvements between groups in those studies may relate to the natural history of vertebral fracture pain, which shows substantial improvement in the conservatively managed patient groups.

The limitations of this study mainly relate to ecologic bias (ie, comparisons are made across studies and not within studies), the presence of publication bias and statistical heterogeneity, and the methodologic limitations of the included studies (lack of random allocation, small sample size, and incomplete baseline and follow-up data). Another limitation relates to the inclusion of only English language literature. However, we attempted to minimize this limitation by asking experts in the field about relevant studies to complement our search strategy.

Conclusions

Pain relief following SA was similar among groups of patients with varying lengths of preoperative pain duration.

Footnotes

Disclosures: David Kallmes. Research Support (including provision of equipment or materials): Cook, ArthroCare, CareFusion, Stryker; Details: research support; Consultant: CareFusion; Details: preparation of education materials.

References

1.↵
1. Alvarez L,
2. Alcaraz M,
3. Perez-Higueras A,
4. et al
. Percutaneous vertebroplasty: functional improvement in patients with osteoporotic compression fractures. Spine 2006; 31: 1113– 18
CrossRef PubMed
2.↵
1. Anselmetti GC,
2. Corrao G,
3. Monica PD,
4. et al
. Pain relief following percutaneous vertebroplasty: results of a series of 283 consecutive patients treated in a single institution. Cardiovasc Intervent Radiol 2007; 30: 441– 47
CrossRef PubMed
3.↵
1. Jha RM,
2. Yoo AJ,
3. Hirsch AE,
4. et al
. Predictors of successful palliation of compression fractures with vertebral augmentation: single-center experience of 525 cases. J Vasc Interv Radiol 2009; 20: 760– 68
CrossRef PubMed
4.↵
1. Layton KF,
2. Thielen KR,
3. Koch CA,
4. et al
. Vertebroplasty, first 1000 levels of a single center: evaluation of the outcomes and complications. AJNR Am J Neuroradiol 2007; 28: 683– 89
Abstract/FREE Full Text
5.↵
1. Masala S,
2. Mastrangeli R,
3. Petrella MC,
4. et al
. Percutaneous vertebroplasty in 1,253 levels: results and long-term effectiveness in a single centre. Eur Radiol 2009; 19: 165– 71
CrossRef PubMed
6.↵
1. Mathis JM,
2. Barr JD,
3. Belkoff SM,
4. et al
. Percutaneous vertebroplasty: a developing standard of care for vertebral compression fractures. AJNR Am J Neuroradiol 2001; 22: 373– 81
FREE Full Text
7.↵
1. McGraw JK,
2. Lippert JA,
3. Minkus KD,
4. et al
. Prospective evaluation of pain relief in 100 patients undergoing percutaneous vertebroplasty: results and follow-up. J Vasc Interv Radiol 2002; 13: 883– 86
PubMed
8.↵
1. Peh WC,
2. Gilula LA,
3. Peck DD
. Percutaneous vertebroplasty for severe osteoporotic vertebral body compression fractures. Radiology 2002; 223: 121– 26
PubMed
9.↵
1. Voormolen MH,
2. Lohle PN,
3. Lampmann LE,
4. et al
. Prospective clinical follow-up after percutaneous vertebroplasty in patients with painful osteoporotic vertebral compression fractures. J Vasc Interv Radiol 2006; 17: 1313– 20
CrossRef PubMed
10.↵
1. Zoarski GH,
2. Snow P,
3. Olan WJ,
4. et al
. Percutaneous vertebroplasty for osteoporotic compression fractures: quantitative prospective evaluation of long-term outcomes. J Vasc Interv Radiol 2002; 13: 139– 48
PubMed
11.↵
1. Barr JD,
2. Barr MS,
3. Lemley TJ,
4. et al
. Percutaneous vertebroplasty for pain relief and spinal stabilization. Spine 2000; 25: 923– 28
CrossRef PubMed
12.↵
1. McGraw JK,
2. Cardella J,
3. Barr JD,
4. et al
. Society of Interventional Radiology quality improvement guidelines for percutaneous vertebroplasty. J Vasc Interv Radiol 2003; 14: S311– S315
PubMed
13.↵
1. Nussbaum DA,
2. Gailloud P,
3. Murphy K
. A review of complications associated with vertebroplasty and kyphoplasty as reported to the Food and Drug Administration medical device related web site. J Vasc Interv Radiol 2004; 15: 1185– 92
CrossRef PubMed
14.↵
1. Peh WC,
2. Gilula LA
. Percutaneous vertebroplasty: Indications, contraindications, and technique. Br J Radiol 2003; 76: 69– 75
Abstract/FREE Full Text
15.↵
1. Alvarez L,
2. Perez-Higueras A,
3. Granizo JJ,
4. et al
. Predictors of outcomes of percutaneous vertebroplasty for osteoporotic vertebral fractures. Spine 2005; 30: 87– 92
PubMed
16.↵
1. Erkan S,
2. Ozalp TR,
3. Yercan HS,
4. et al
. Does timing matter in performing kyphoplasty? Acute versus chronic compression fractures. Acta Orthop Belg 2009; 75: 396– 404
PubMed
17.↵
1. Kaufmann TJ,
2. Jensen ME,
3. Schweickert PA,
4. et al
. Age of fracture and clinical outcomes of percutaneous vertebroplasty. AJNR Am J Neuroradiol 2001; 22: 1860– 63
Abstract/FREE Full Text
18.↵
1. Atalay B,
2. Caner H,
3. Gokce C,
4. et al
. Kyphoplasty: 2 years of experience in a neurosurgery department. Surg Neurol 2005; 64 (suppl 2): S72– 76
CrossRef PubMed
19.↵
1. Chen LH,
2. Niu CC,
3. Yu SW,
4. et al
. Minimally invasive treatment of osteoporotic vertebral compression fracture. Chang Gung Med J 2004; 27: 261– 67
PubMed
20.↵
1. Diamond TH,
2. Bryant C,
3. Browne L,
4. et al
. Clinical outcomes after acute osteoporotic vertebral fractures: a 2-year non-randomised trial comparing percutaneous vertebroplasty with conservative therapy. Med J Aust 2006; 184: 113– 17
PubMed
21.↵
1. Garfin SR,
2. Buckley RA,
3. Ledlie J
. Balloon kyphoplasty for symptomatic vertebral body compression fractures results in rapid, significant, and sustained improvements in back pain, function, and quality of life for elderly patients. Spine (Phila Pa 1976) 2006; 31: 2213– 20
CrossRef
22.↵
1. Wiggins MC,
2. Sehizadeh M,
3. Pilgram TK,
4. et al
. Importance of intravertebral fracture clefts in vertebroplasty outcome. AJR Am J Roentgenol 2007; 188: 634– 40
CrossRef PubMed
23.↵
1. DerSimonian R,
2. Laird N
. Meta-analysis in clinical trials. Control Clin Trials 1986; 7: 177– 88
CrossRef PubMed
24.↵
1. Higgins J,
2. Thompson S,
3. Deeks J,
4. et al
. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557– 60
FREE Full Text
25.↵
1. Rhyne A 3rd.,
2. Banit D,
3. Laxer E,
4. et al
. Kyphoplasty: report of eighty-two thoracolumbar osteoporotic vertebral fractures. J Orthop Trauma 2004; 18: 294– 99
CrossRef PubMed
26.↵
1. Vogl TJ,
2. Proschek D,
3. Schwarz W,
4. et al
. CT-guided percutaneous vertebroplasty in the therapy of vertebral compression fractures. Eur Radiol 2006; 16: 797– 803
CrossRef PubMed
27.↵
1. Hozo SP,
2. Djulbegovic B,
3. Hozo I
. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 2005; 5: 13
28.↵
1. Kallmes DF,
2. Comstock BA,
3. Heagerty PJ,
4. et al
. A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med 2009; 361: 569– 79
CrossRef PubMed
29.↵
1. Kobayashi K,
2. Shimoyama K,
3. Nakamura K,
4. et al
. Percutaneous vertebroplasty immediately relieves pain of osteoporotic vertebral compression fractures and prevents prolonged immobilization of patients. Eur Radiol 2005; 15: 360– 67
CrossRef PubMed
30.↵
1. Lee SB,
2. Cho KS,
3. Huh PW,
4. et al
. Clinical and radiographic results of unilateral transpedicular balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures. Acta Neurochir Suppl 2008; 101: 157– 60
CrossRef PubMed
31.↵
1. Liu JT,
2. Liao WJ,
3. Tan WC,
4. et al
. Balloon kyphoplasty versus vertebroplasty for treatment of osteoporotic vertebral compression fracture: a prospective, comparative, and randomized clinical study. Osteoporos Int 2010; 21: 359– 64. Epub 2009 Jun 10
CrossRef PubMed
32.↵
1. Prather H,
2. Van Dillen L,
3. Metzler JP,
4. et al
. Prospective measurement of function and pain in patients with non-neoplastic compression fractures treated with vertebroplasty. J Bone Joint Surg Am 2006; 88: 334– 41
CrossRef PubMed
33.↵
1. Rapan S,
2. Jovanovic S,
3. Gulan G
. Vertebroplasty for vertebral compression fracture. Coll Antropol 2009; 33: 911– 14
PubMed
34.↵
1. Rollinghoff M,
2. Siewe J,
3. Zarghooni K,
4. et al
. Effectiveness, security and height restoration on fresh compression fractures: a comparative prospective study of vertebroplasty and kyphoplasty. Minim Invasive Neurosurg 2009; 52: 233– 37. Epub 2010 Jan 14fs
CrossRef PubMed
35.↵
1. Rousing R,
2. Andersen MO,
3. Jespersen SM,
4. et al
. Percutaneous vertebroplasty compared to conservative treatment in patients with painful acute or subacute osteoporotic vertebral fractures: three-months follow-up in a clinical randomized study. Spine (Phila Pa 1976) 2009; 34: 1349– 54
CrossRef
36.↵
1. Schofer MD,
2. Efe T,
3. Timmesfeld N,
4. et al
. Comparison of kyphoplasty and vertebroplasty in the treatment of fresh vertebral compression fractures. Arch Orthop Trauma Surg 2009; 129: 1391– 99
CrossRef PubMed
37.↵
1. Wardlaw D,
2. Cummings SR,
3. Van Meirhaeghe J,
4. et al
. Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (free): a randomised controlled trial. Lancet 2009; 373: 1016– 24
CrossRef PubMed
38.↵
1. Ryu KS,
2. Park CK
. The prognostic factors influencing on the therapeutic effect of percutaneous vertebroplasty in treating osteoporotic vertebral compression fractures. J Korean Neurosurg Soc 2009; 45: 16– 23. Epub 2009 Jan 31
CrossRef PubMed

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Is Severe Pain Immediately after Spinal Augmentation a Predictor of Long-Term Outcomes?

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Show more SPINE

[1] 1.↵
Alvarez L,
Alcaraz M,
Perez-Higueras A,
et al
. Percutaneous vertebroplasty: functional improvement in patients with osteoporotic compression fractures. Spine 2006; 31: 1113– 18
CrossRef PubMed

[2] Alvarez L,

[3] Alcaraz M,

[4] Perez-Higueras A,

[5] et al

[6] 2.↵
Anselmetti GC,
Corrao G,
Monica PD,
et al
. Pain relief following percutaneous vertebroplasty: results of a series of 283 consecutive patients treated in a single institution. Cardiovasc Intervent Radiol 2007; 30: 441– 47
CrossRef PubMed

[7] Anselmetti GC,

[8] Corrao G,

[9] Monica PD,

[10] et al

[11] 3.↵
Jha RM,
Yoo AJ,
Hirsch AE,
et al
. Predictors of successful palliation of compression fractures with vertebral augmentation: single-center experience of 525 cases. J Vasc Interv Radiol 2009; 20: 760– 68
CrossRef PubMed

[12] Jha RM,

[13] Yoo AJ,

[14] Hirsch AE,

[15] et al

[16] 4.↵
Layton KF,
Thielen KR,
Koch CA,
et al
. Vertebroplasty, first 1000 levels of a single center: evaluation of the outcomes and complications. AJNR Am J Neuroradiol 2007; 28: 683– 89
Abstract/FREE Full Text

[17] Layton KF,

[18] Thielen KR,

[19] Koch CA,

[20] et al

[21] 5.↵
Masala S,
Mastrangeli R,
Petrella MC,
et al
. Percutaneous vertebroplasty in 1,253 levels: results and long-term effectiveness in a single centre. Eur Radiol 2009; 19: 165– 71
CrossRef PubMed

[22] Masala S,

[23] Mastrangeli R,

[24] Petrella MC,

[25] et al

[26] 6.↵
Mathis JM,
Barr JD,
Belkoff SM,
et al
. Percutaneous vertebroplasty: a developing standard of care for vertebral compression fractures. AJNR Am J Neuroradiol 2001; 22: 373– 81
FREE Full Text

[27] Mathis JM,

[28] Barr JD,

[29] Belkoff SM,

[30] et al

[31] 7.↵
McGraw JK,
Lippert JA,
Minkus KD,
et al
. Prospective evaluation of pain relief in 100 patients undergoing percutaneous vertebroplasty: results and follow-up. J Vasc Interv Radiol 2002; 13: 883– 86
PubMed

[32] McGraw JK,

[33] Lippert JA,

[34] Minkus KD,

[35] et al

[36] 8.↵
Peh WC,
Gilula LA,
Peck DD
. Percutaneous vertebroplasty for severe osteoporotic vertebral body compression fractures. Radiology 2002; 223: 121– 26
PubMed

[37] Peh WC,

[38] Gilula LA,

[39] Peck DD

[40] 9.↵
Voormolen MH,
Lohle PN,
Lampmann LE,
et al
. Prospective clinical follow-up after percutaneous vertebroplasty in patients with painful osteoporotic vertebral compression fractures. J Vasc Interv Radiol 2006; 17: 1313– 20
CrossRef PubMed

[41] Voormolen MH,

[42] Lohle PN,

[43] Lampmann LE,

[44] et al

[45] 10.↵
Zoarski GH,
Snow P,
Olan WJ,
et al
. Percutaneous vertebroplasty for osteoporotic compression fractures: quantitative prospective evaluation of long-term outcomes. J Vasc Interv Radiol 2002; 13: 139– 48
PubMed

[46] Zoarski GH,

[47] Snow P,

[48] Olan WJ,

[49] et al

[50] 11.↵
Barr JD,
Barr MS,
Lemley TJ,
et al
. Percutaneous vertebroplasty for pain relief and spinal stabilization. Spine 2000; 25: 923– 28
CrossRef PubMed

[51] Barr JD,

[52] Barr MS,

[53] Lemley TJ,

[54] et al

[55] 12.↵
McGraw JK,
Cardella J,
Barr JD,
et al
. Society of Interventional Radiology quality improvement guidelines for percutaneous vertebroplasty. J Vasc Interv Radiol 2003; 14: S311– S315
PubMed

[56] McGraw JK,

[57] Cardella J,

[58] Barr JD,

[59] et al

[60] 13.↵
Nussbaum DA,
Gailloud P,
Murphy K
. A review of complications associated with vertebroplasty and kyphoplasty as reported to the Food and Drug Administration medical device related web site. J Vasc Interv Radiol 2004; 15: 1185– 92
CrossRef PubMed

[61] Nussbaum DA,

[62] Gailloud P,

[63] Murphy K

[64] 14.↵
Peh WC,
Gilula LA
. Percutaneous vertebroplasty: Indications, contraindications, and technique. Br J Radiol 2003; 76: 69– 75
Abstract/FREE Full Text

[65] Peh WC,

[66] Gilula LA

[67] 15.↵
Alvarez L,
Perez-Higueras A,
Granizo JJ,
et al
. Predictors of outcomes of percutaneous vertebroplasty for osteoporotic vertebral fractures. Spine 2005; 30: 87– 92
PubMed

[68] Alvarez L,

[69] Perez-Higueras A,

[70] Granizo JJ,

[71] et al

[72] 16.↵
Erkan S,
Ozalp TR,
Yercan HS,
et al
. Does timing matter in performing kyphoplasty? Acute versus chronic compression fractures. Acta Orthop Belg 2009; 75: 396– 404
PubMed

[73] Erkan S,

[74] Ozalp TR,

[75] Yercan HS,

[76] et al

[77] 17.↵
Kaufmann TJ,
Jensen ME,
Schweickert PA,
et al
. Age of fracture and clinical outcomes of percutaneous vertebroplasty. AJNR Am J Neuroradiol 2001; 22: 1860– 63
Abstract/FREE Full Text

[78] Kaufmann TJ,

[79] Jensen ME,

[80] Schweickert PA,

[81] et al

[82] 18.↵
Atalay B,
Caner H,
Gokce C,
et al
. Kyphoplasty: 2 years of experience in a neurosurgery department. Surg Neurol 2005; 64 (suppl 2): S72– 76
CrossRef PubMed

[83] Atalay B,

[84] Caner H,

[85] Gokce C,

[86] et al

[87] 19.↵
Chen LH,
Niu CC,
Yu SW,
et al
. Minimally invasive treatment of osteoporotic vertebral compression fracture. Chang Gung Med J 2004; 27: 261– 67
PubMed

[88] Chen LH,

[89] Niu CC,

[90] Yu SW,

[91] et al

[92] 20.↵
Diamond TH,
Bryant C,
Browne L,
et al
. Clinical outcomes after acute osteoporotic vertebral fractures: a 2-year non-randomised trial comparing percutaneous vertebroplasty with conservative therapy. Med J Aust 2006; 184: 113– 17
PubMed

[93] Diamond TH,

[94] Bryant C,

[95] Browne L,

[96] et al

[97] 21.↵
Garfin SR,
Buckley RA,
Ledlie J
. Balloon kyphoplasty for symptomatic vertebral body compression fractures results in rapid, significant, and sustained improvements in back pain, function, and quality of life for elderly patients. Spine (Phila Pa 1976) 2006; 31: 2213– 20
CrossRef

[98] Garfin SR,

[99] Buckley RA,

[100] Ledlie J

[101] 22.↵
Wiggins MC,
Sehizadeh M,
Pilgram TK,
et al
. Importance of intravertebral fracture clefts in vertebroplasty outcome. AJR Am J Roentgenol 2007; 188: 634– 40
CrossRef PubMed

[102] Wiggins MC,

[103] Sehizadeh M,

[104] Pilgram TK,

[105] et al

[106] 23.↵
DerSimonian R,
Laird N
. Meta-analysis in clinical trials. Control Clin Trials 1986; 7: 177– 88
CrossRef PubMed

[107] DerSimonian R,

[108] Laird N

[109] 24.↵
Higgins J,
Thompson S,
Deeks J,
et al
. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557– 60
FREE Full Text

[110] Higgins J,

[111] Thompson S,

[112] Deeks J,

[113] et al

[114] 25.↵
Rhyne A 3rd.,
Banit D,
Laxer E,
et al
. Kyphoplasty: report of eighty-two thoracolumbar osteoporotic vertebral fractures. J Orthop Trauma 2004; 18: 294– 99
CrossRef PubMed

[115] Rhyne A 3rd.,

[116] Banit D,

[117] Laxer E,

[118] et al

[119] 26.↵
Vogl TJ,
Proschek D,
Schwarz W,
et al
. CT-guided percutaneous vertebroplasty in the therapy of vertebral compression fractures. Eur Radiol 2006; 16: 797– 803
CrossRef PubMed

[120] Vogl TJ,

[121] Proschek D,

[122] Schwarz W,

[123] et al

[124] 27.↵
Hozo SP,
Djulbegovic B,
Hozo I
. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 2005; 5: 13

[125] Hozo SP,

[126] Djulbegovic B,

[127] Hozo I

[128] 28.↵
Kallmes DF,
Comstock BA,
Heagerty PJ,
et al
. A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med 2009; 361: 569– 79
CrossRef PubMed

[129] Kallmes DF,

[130] Comstock BA,

[131] Heagerty PJ,

[132] et al

[133] 29.↵
Kobayashi K,
Shimoyama K,
Nakamura K,
et al
. Percutaneous vertebroplasty immediately relieves pain of osteoporotic vertebral compression fractures and prevents prolonged immobilization of patients. Eur Radiol 2005; 15: 360– 67
CrossRef PubMed

[134] Kobayashi K,

[135] Shimoyama K,

[136] Nakamura K,

[137] et al

[138] 30.↵
Lee SB,
Cho KS,
Huh PW,
et al
. Clinical and radiographic results of unilateral transpedicular balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures. Acta Neurochir Suppl 2008; 101: 157– 60
CrossRef PubMed

[139] Lee SB,

[140] Cho KS,

[141] Huh PW,

[142] et al

[143] 31.↵
Liu JT,
Liao WJ,
Tan WC,
et al
. Balloon kyphoplasty versus vertebroplasty for treatment of osteoporotic vertebral compression fracture: a prospective, comparative, and randomized clinical study. Osteoporos Int 2010; 21: 359– 64. Epub 2009 Jun 10
CrossRef PubMed

[144] Liu JT,

[145] Liao WJ,

[146] Tan WC,

[147] et al

[148] 32.↵
Prather H,
Van Dillen L,
Metzler JP,
et al
. Prospective measurement of function and pain in patients with non-neoplastic compression fractures treated with vertebroplasty. J Bone Joint Surg Am 2006; 88: 334– 41
CrossRef PubMed

[149] Prather H,

[150] Van Dillen L,

[151] Metzler JP,

[152] et al

[153] 33.↵
Rapan S,
Jovanovic S,
Gulan G
. Vertebroplasty for vertebral compression fracture. Coll Antropol 2009; 33: 911– 14
PubMed

[154] Rapan S,

[155] Jovanovic S,

[156] Gulan G

[157] 34.↵
Rollinghoff M,
Siewe J,
Zarghooni K,
et al
. Effectiveness, security and height restoration on fresh compression fractures: a comparative prospective study of vertebroplasty and kyphoplasty. Minim Invasive Neurosurg 2009; 52: 233– 37. Epub 2010 Jan 14fs
CrossRef PubMed

[158] Rollinghoff M,

[159] Siewe J,

[160] Zarghooni K,

[161] et al

[162] 35.↵
Rousing R,
Andersen MO,
Jespersen SM,
et al
. Percutaneous vertebroplasty compared to conservative treatment in patients with painful acute or subacute osteoporotic vertebral fractures: three-months follow-up in a clinical randomized study. Spine (Phila Pa 1976) 2009; 34: 1349– 54
CrossRef

[163] Rousing R,

[164] Andersen MO,

[165] Jespersen SM,

[166] et al

[167] 36.↵
Schofer MD,
Efe T,
Timmesfeld N,
et al
. Comparison of kyphoplasty and vertebroplasty in the treatment of fresh vertebral compression fractures. Arch Orthop Trauma Surg 2009; 129: 1391– 99
CrossRef PubMed

[168] Schofer MD,

[169] Efe T,

[170] Timmesfeld N,

[171] et al

[172] 37.↵
Wardlaw D,
Cummings SR,
Van Meirhaeghe J,
et al
. Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (free): a randomised controlled trial. Lancet 2009; 373: 1016– 24
CrossRef PubMed

[173] Wardlaw D,

[174] Cummings SR,

[175] Van Meirhaeghe J,

[176] et al

[177] 38.↵
Ryu KS,
Park CK
. The prognostic factors influencing on the therapeutic effect of percutaneous vertebroplasty in treating osteoporotic vertebral compression fractures. J Korean Neurosurg Soc 2009; 45: 16– 23. Epub 2009 Jan 31
CrossRef PubMed

[178] Ryu KS,

[179] Park CK

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The Association between the Duration of Preoperative Pain and Pain Improvement in Vertebral Augmentation: A Meta-Analysis

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The Association between the Duration of Preoperative Pain and Pain Improvement in Vertebral Augmentation: A Meta-Analysis

Abstract

ABBREVIATIONS:

Materials and Methods

Statistical Analysis

Results

Discussion

Conclusions

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