Percutaneous Vertebroplasty vs. Conservative Care: A Meta-Analysis of Randomized Controlled Trials Comparing Pain Relief and Quality of Life in Osteoporotic Vertebral Fractures

Introduction: Osteoporotic vertebral fractures frequently result in pain and decreased quality of life. The management of these fractures remains a topic of debate. Therefore, we conducted a meta-analysis to compare the clinical outcomes of percutaneous vertebroplasty against conservative treatment in patients with osteoporotic vertebral fractures.

Methods: Following PRISMA guideline, randomized controlled trials comparing percutaneous vertebroplasty to conservative care were assessed. The outcomes of interest included pain relief across various time points and the impact on quality of life over a one-year observation period.

Results: Regarding pain relief, vertebroplasty yielded significant improvement compared to conservative treatment at 1-2 weeks (mean difference: -1.92 95% CI -2.45; -1.38, I²=73%). This effect was not maintained throughout the 1, 3, 6 and 12-month timepoints. For Quality of Life (QoL), notable improvements were observed at 1 week (mean difference: -3.15, 95% CI -3.92; -2.39, I²=65%), which was also not sustained across the remaining evaluations (1,3, 6 and 12 months). Meta-regression suggested the Mean Difference between control and intervention at baseline accounted for 100% of the heterogeneity observed for pain and QoL at 1 - 2 weeks following intervention.

Conclusion : Percutaneous vertebroplasty emerges as a promising intervention for initial pain alleviation and improvement in quality of life up to 1 - 2 weeks following procedure. The efficacy compared to control is not sustained throughout the first year following intervention. The observed study heterogeneity is justifiable by the initial variability between control-intervention group scores at baseline.