Liu, J. T. et al. Balloon kyphoplasty versus vertebroplasty for treatment of osteoporotic vertebral compression fracture: a prospective, comparative, and randomized clinical study. Osteoporos Int. doi:10.1007/s00198-009-0952-8

Two distinct procedures for the treatment of vertical compression fractures do not markedly differ in their beneficial effects, a comparative, randomized clinical trial by investigators from Chung-Shan Medical University, Taiwan, has found.

Vertical compression fractures are common among patients with osteoporosis or multiple myeloma. Spinal stability and vertical height are restored by injection of acrylic cement, predominantly polymethylmethacrylate, either directly into the fracture (vertebroplasty) or through an inflatable balloon inserted into the collapsed vertebrae (kyphoplasty). Both techniques are widely established, minimally invasive procedures, but a direct comparison to discern superiority of one method over the other was lacking.

Liu and colleagues randomly allocated 100 patients with osteoporotic compression fractures at the thoraco–lumbar junction to undergo either vertebroplasty or kyphoplasty. The investigators compared radiological and clinical outcomes of the two procedures by assessment of postoperative vertebral body height, kyphotic wedge angle—the angle at which the vertebral body deviates from its normal shape—and pain scores, with a final follow-up of pain outcome after 6 months.

All parameters that were analyzed postoperatively improved appreciably when compared with preoperative values; however, Liu et al. found no difference in pain outcome between the two surgical procedures 3 days after surgery, nor at the final follow-up.

As the clinical outcome of this study revealed no substantial superiority of either method, the researchers, with consideration of cost-effectiveness, recommend use of vertebroplasty for the treatment of vertical compression fractures in patients with osteoporosis, at least until long-term clinical outcomes are fully assessed.