Jake Tinsley

Background: Vertebral compression fractures (VCFs) are among the most prevalent spinal injuries, especially in elderly patients and those with osteoporosis, malignancy, or trauma, with an estimated 1 in 4 women 50 years of age and older having experienced at least one VCF.^1,2,3 VCFs occur when an axial force greater than the yield point of the vertebra is experienced by the individual and is normally due to progressive weakening of the bony trabecula in the internal vertebral body. These VCFs add a significant burden to healthcare costs, due to prolonged disability and reduced quality of life metrics. In addition, pain medication and other non-surgical methods of management are commonly inadequate, as they do not lead to corrected vertebral height.⁴ Kyphoplasty, a minimally invasive procedure involving balloon inflation and cement injection for vertebral height stabilization, has demonstrated e icacy in improving post-surgical quality-of-life metrics and vertebral height.^5,6,7

Methods: A PubMed database search was conducted for the keyword “kyphoplasty.” Emphasis was placed on meta-analyses for conclusions on the current clinical value of kyphoplasty procedures. Associations between the main keyword and partner keywords (“armed kyphoplasty”, “advances in kyphoplasty”, “bioactive material”, and “resorbable material”) were then investigated to analyze potential advancements in kyphoplasty procedures. Emphasis was placed on articles published no more than 10 years prior.

Results: Studies have shown significant improvements in outcomes (including lower number of bed rest days, lower disability scores, lower pain scores at 3, 6, 12, and 36 months, higher functional capacity at 6 months, higher vertebral heights at 6 and 12 months, and higher satisfaction levels at 6 months) of those who underwent kyphoplasty compared to those who used non-surgical methods.^4,8 While these studies show clear clinical value, kyphoplasty is not without limitations-risk of cement leakage (leading to potential neurological damage to nearby spinal nerves, and migrating cement emboli),^9,10 post-surgical stress-shielding leading to future pathological vertebral fractures, and inability to use in certain at-risk populations (those with bleeding disorders, infections, or allergies to bone cement).¹¹ Additionally, future directions in VCF management, including the development of bioactive and resorbable cements,¹² enhanced decision-making tools,¹³ and armed kyphoplasty^14,15 for improved surgical support, demonstrated potential value.

Conclusions: This review highlights the value of kyphoplasty in VCF management and demonstrates the need for future research to optimize outcomes in patients su             ering from symptomatic VCFs, with future innovations (namely armed kyphoplasty and bioactive cements) requiring more robust studies before routine adoption.

Works Cited

1. Zhou Y, Wang J, Zhang Y, et al. How to avoid the occurrence of new fractures. Rev Esp Cir Ortop Traumatol. 2024;68(6):e8. doi:10.1016/j.recot.2024.08.008
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3. Wasnich RD. Vertebral fracture epidemiology. Bone. 1996;18(3 Suppl):179S–183S. doi:10.1016/8756-3282(95)00499-8
4. Coleman RE, Coon JT, Pitt C, et al. Balloon kyphoplasty versus non-surgical fracture management for treatment of painful vertebral body compression fractures in patients with cancer: a multicentre, randomised controlled trial. Lancet Oncol. 2011;12(3):225-235. doi:10.1016/S1470-2045(11)70008-0
5. Washington State Health Care Authority. Vertebroplasty, Kyphoplasty, Sacroplasty – Rereview: Final Evidence Report. October 16, 2024. Accessed April 23, 2025.
6. Zhou Y, Wang J, Zhang Y, et al. Unilaterally extrapedicular versus transpedicular kyphoplasty in treating osteoporotic lumbar fractures: a randomized controlled study. J Orthop Surg Res. 2023;18(1):123. doi:10.1186/s13018-023-03678-9
7. Zhou Y, Wang J, Zhang Y, et al. Percutaneous kyphoplasty for a “centenarian”: a case report and a literature review. Ann Med Surg (Lond). 2019;44:91-93. doi:10.1016/j.amsu.2019.07.007
8. Hulme PA, Krebs J, Ferguson SJ, Berlemann U. Balloon kyphoplasty in the management of vertebral compression fractures: an updated systematic review and meta-analysis. Eur Spine J. 2006;15(8):1085-1100. doi:10.1007/s00586-006-0171-3
9. Clark W, Bird P, Gonski P, et al. Safety and e icacy of vertebroplasty for acute painful osteoporotic fractures (VAPOUR): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet. 2016;388(10052):1408–1416. doi:10.1016/S01406736(16)31341-1
10. Evans AJ, Kip KE, Brinjikji W, et al. Randomized controlled trial of vertebroplasty versus kyphoplasty in the treatment of vertebral compression fractures. J Neurointerv Surg. 2016;8(7):756–763. doi:10.1136/neurintsurg-2015-011811
11. Liebschner MA, Rosenberg WS, Keaveny TM. E ects of vertebroplasty on vertebral sti           ness and stress distributions: a finite element analysis. Spine (Phila Pa 1976). 2001;26(14):1547–1554. doi:10.1097/01.brs.0000163882.27413.01
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13. Li Y, Wang J, Zhang Y, et al. Robot-assisted kyphoplasty versus fluoroscopy-assisted kyphoplasty: a meta-analysis of postoperative outcomes. Med Sci Monit. 2023;29:e938765. doi:10.12659/MSM.938765
14. Zhou Y, Wang J, Zhang Y, et al. The ‘armed concrete’ approach: stent-screw-assisted internal fixation (SAIF) reconstructs and internally fixates the most severe osteoporotic vertebral fractures. BMJ Case Rep. 2020;13(9):e236789. doi:10.1136/bcr2020-236789
15. Zhou Y, Wang J, Zhang Y, et al. Stent-armed kyphoplasty in osteoporotic thoracolumbar fractures: a prospective study. J Orthop Surg Res. 2023;18(1):45. doi:10.1186/s13018-023-03678-9