Shawn JS Seah, Mark HX Yeo, Jun-Hao Tan, Hwee Weng Dennis Hey

May 2023, Volume 32, Issue 5, pp 1751 - 1762 Review Article Read Full Article 10.1007/s00586-023-07658-9

First Online: 25 March 2023


The incidence of osteoporotic compression fractures (VCFs) have been rising over the past decades. Presently, vertebral cement augmentation procedures such as balloon kyphoplasty and vertebroplasty are common treatments allowing pain relief and functional recovery. However, there is controversy on whether different timeframes for cement augmentation affects clinical outcomes. Hence, this study aimed to compare pain relief and complication rates between early versus late cement augmentation.


A comprehensive systematic review of PubMed, EMBASE, Scopus and Cochrane Library was conducted, identifying studies that compared early versus late cement augmentation for VCFs. As the definitions of "early" and "late" phases across studies are heterogenous, we established the cut-off between early and late phase as intervals to accommodate as many studies as possible for analysis. We conducted two separate analyses with different cut-off intervals and included studies that reported interventions within these respective time intervals. In analysis 1, we included studies which grouped patients into “early” and “late” group based on a cut-off time frame of 2–4 weeks. On the other hand, in analysis 2, we included studies which grouped patients into “early” and “late” groups based on a cut-off time frame of 6–8 weeks. Meta-analysis was conducted via random-effect models, comparing outcomes of interest between early and late groups.


Eleven studies were included. The total cohort size was 712 and 775 patients in analysis 1 and 2 respectively. Mean follow-up was 12.9 ± 3.7 months and 11 ± 0.6 months respectively. VAS change at final follow-up was significantly greater in the early group for both analyses. (MD = − 0.66, p = 0.01; and MD = − 1.18, p 


Both early and late timeframes for cement augmentation offered significant improvement in pain relief, with similar post-operative absolute pain score, kyphotic angle, cement leakage and adjacent vertebral fractures. Early surgery may offer substantial pain relief in patients presenting with pain as early as 

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