Unit:
Κατεύθυνση Κλινικές Μελέτες: Σχεδιασμός και ΕκτέλεσηLibrary of the School of Health Sciences
Author:
Masouros Panagiotis
Supervisors info:
Ευάγγελος Τέρπος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Μαρία Γαβριατοπούλου, Επίκουρη Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Φλώρα Ζαγουρή, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Μετα-ανάλυση των αποτελεσμάτων της αντιμετώπισης παθολογικών σπονδυλικών καταγμάτων σε ασθενείς με πολλαπλούν μυέλωμα με τη χρήση κυφοπλαστικής/σπονδυλοπλαστικής.
Translated title:
Kyphoplasty and vertebroplasty for the treatment of pathologic vertebral fractures secondary to multiple myeloma: A meta-analysis
Summary:
Background: Vertebral fractures are a leading cause of disability and pain among patients with multiple myeloma, while they are associated with increased morbidity and mortality. Kyphoplasty and vertebroplasty are minimally invasive procedures, which have been succesfully implemented in the treatment of benign fractures. The objective of this study was to assess the outcomes of these techniques in myelotic populations and provide a quantitive synthesis of these data.
Material and methods: A systematic search of the literature was conducted on Pubmed and Cochrane Library Database until January 2019 seeking articles, which reported on the application of vertebral augmentation procedures in patients with spinal fractures secondary to multiple myeloma. The included studies were evaluated for methodological quality and the risk of bias was assessed. The effect size was estimated using a random effect model on Review Manager 5.1 Software. A sensitivity analysis was performed in order to detect possible heterogeneity factors.
Results: 13 studies out of 258 were included. Six studies compared KP/VP to conventional treatment, while the rest had a single-cohort design. Weighted mean difference in VAS and ODI scales were estimated to be 5.21; 95% CI: 4.30-6.11 and 32.09; 95% CI: 23.1-42.7 respectively. Comparison to conventional treatment revealed that KP and VP were associated with superior outcomes in terms of pain relief (2.05; 95%CI: 1.16-2.94, expressed as mean difference between the two treatment groups). Mortality rates were lower for the surgery groups, but not to a statistically significant level.
Conclusion: It appears that kyphoplasty and vertebroplasty are quite effective, safe and well-tolerated procedures. They offer improved clinical outcomes, both short- and long-term, when compared to conventional treatment. However, the overall impact on patients’ quality of life and survival indices have yet to be defined. High quality RCTs are required in order to establish Level I evidence on their long-term superiority.
Main subject category:
Health Sciences
Keywords:
Kyphoplasty, Vertebroplasty, Pathologic vertebral fractures, Multiple myeloma
File:
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Masouros_Panagiotis_Master.pdf
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