The effectiveness of balloon kyphoplasty compared to conservative treatment for osteoporotic vertebral compression fractures: A systematic review and meta-analysis

Background: 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. Objectives: To evaluate the effectiveness of BKP versus conservative treatment for pain, quality of life, and function in patients with painful OVCFs. Primary outcome: Pain improvement up to 12 months after BKP. Secondary outcomes: Functional improvement, adverse events, and vertebral body height restoration. Methods: 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. Results: 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. Conclusion: 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.