Table 1. Scores for pain, disability, and physical function in patients before and after kyphoplasty and vertebroplasty.
†Statistically significant.
Abbreviations: Pt, patient; KP, kyphoplasty; VP, vertebroplasty; NRS, pain numeric rating score; ODI, Oswestry disability index; VAS, visual analogue scale; RDQ, Rolland Disability Questionnaire; KPS, Karnofsky performance score; Sig., significant; MM, multiple myeloma; mo, month; NA, not applicable; Postop, postoperatively; Preop, preoperatively; CI, confidence interval.
| Study | Median Pt Age | # Pts | Procedure (# cases) | Pathology (#cases) | Pain Relief: improvement in scores postop | Karnofsky Performance Status | Improvement in Disability Scores after KP/VP | Summary |
| Berenson 2011 [27]: Randomized Controlled Multicenter Trial | KP: 64.8, Control:63 | 134 | KP(68) vs. medical management (61) | Multiple Myeloma: KP (22), nonsurgical (27) | †Difference in reduction of NRS score between KP and medical management. KP > medical. | †Improvement in KP group compared to nonsurgical group (mean improvement): 15.3 points (95% CI, 13.5 to 17.1; p < .0001) | †RDQ treatment effect after KP: -8.4 points (95% CI, -7.6 to -9.2; p < .0001) | Sig. reductions in mean pain scores (NRS), KPS, RMQ for KP at one month, but not in nonsurgical group. |
| Metastatic Cancer: KP (46), medical (34) | 1 week: -3.5 (95% CI, -3.8 to -3.2; p < .0001) | |||||||
| 1 mo.: -3.3 (95% CI, -3.6 to -3.0; p < .0001) l (95% CI, p < .0001). | ||||||||
| Fourney 2003 [24]: Retrospective Review | 64 | 56 | KP (34), VP (15), KP+VP (7) | Metastatic cancer (35), Multiple Myeloma (21) | †Improvement in VAS: | NA | NA | Sig. reductions in VAS in KP patients with MM and spinal metastases compared to baseline, with significance maintained at 6 mo. for VP, and at one year for KP. |
| immediately postop: BKP, VP (p < .05). | ||||||||
| 6 mo.: KP, VP (p < .05) | ||||||||
| 12 mo.:KP (p < .05) | ||||||||
| Markmiller 2015 [28]: longitudinal prospective case series | 68.7 | 115 | Kyphoplasty | Metastatic Cancer (92), Multiple Myeloma (23) | †Median VAS after KP: | †Median: | †Improvement in mean ODI after KP: | Sig. improvements in median KPS, mean ODI, and median VAS with KP through 12 mo. |
| Postop: -4.0 (95% CI -5.0 to -3.0; p < .0001) | Postop: 15 (95% CI; p < .0001) | Postop: -49.6 (95% CI, -56.4 to -42.1 p < .0001) | ||||||
| 12 mo.: -3.5 (95% CI -5.0 to -3.0 ( p < .0001) | 12 mo: 10 (95% CI; p < .0001) | 12 mo.: -48.4 (95% CI, -56.4 to -42.1 p < .0001) | ||||||
| McDonald 2009 [29]: retrospective review | 66.2 | 67 | VP (67) | Multiple Myeloma (67) | †median improvement in VAS after VP: | NA | †Improvement in median RDQ scores after VP: | Sig. improvements in median VAS, RDQ in patients with MM after VP through 12 mo. |
| At rest: -2.7 (95% CI, -3.7 to 1.7; p < .0001 at one week, < .03 at one year) | one week: -11 (95% CI -14.3 to -7.7; p < .0001) | |||||||
| With activity: -5.3 (95% CI, -6.4 to -4.2 p < .0001 at one week, p < .001 at one year) | one year: (p < .001) | |||||||
| Papanastassiou 2014 [31]: retrospective comparative study | 61.6 | 69 | KP: unilateral versus bilateral (69) | Multiple Myeloma (69) | †Change in mean VAS in unilateral and bilateral KP, respectively from baseline | NA | NA | Sig. improvement in mean VAS scores in patients with MM after both unilateral and bilateral kyphoplasty, with no difference in pain reduction between the two techniques. |
| Postop: -5.4, -5.5(95% CI, p<.0005) | ||||||||
| 3 mo.: p<.0005 | ||||||||
| Pflugmacher 2006 [30]: Longitudinal prospective case series | 62.4 | 20 | KP(20) | Multiple Myeloma (20) | †Change in mean VAS: | NA | †Improvement in mean ODI: | Sig. improvements in mean VAS, ODI with KP in patients with multiple myeloma through one year. |
| Preop: 71.5% (39-89%) | ||||||||
| Postop: -6 (95% CI; p < .05) | 3 mo. postop: 27.5% improvement 27.5% (95% CI, 11 to 41%; p < .05) | |||||||
| 12 mo.: -5.1 (95% CI; p < .05) | 12 mo.:(95% CI, 13 to 52%; p < .05) |