A Comprehensive Analysis of Vertebroplasty and Kyphoplasty for Osteoporotic Vertebral Compression Fractures and Postoperative Sagittal Balance.

Background: Osteoporotic vertebral compression fractures (OVCFs) lead to posture restrictions, back muscle fatigue, difficulty walking, impaired lung function, an increased risk of disability, and severe pain. Collectively, these symptoms significantly diminish patients' quality of life. While non-surgical management is often attempted, it may prove inadequate for cases involving walking difficulties and sagittal imbalance. In such instances, surgical interventions like vertebroplasty (VP) and kyphoplasty (KP) become necessary. To our knowledge, no study in the literature has directly compared VP and KP in terms of their effectiveness in improving sagittal balance.

Aim: This study aims to compare the clinical and radiological outcomes of VP and KP, with a specific focus on their impact on global spinal alignment and sagittal balance.

Methods: Seventy-six patients with OVCFs (mean age: 64.12 ± 11.85 years) underwent either kyphoplasty (59%) or vertebroplasty (41%). Radiological parameters, clinical outcomes, operation time, and complications were evaluated at 6-month, 12-month, and 24-month follow-ups. The improvement in sagittal balance was compared between the KP and VP groups.

Results: Only KP significantly increased vertebral height, though no significant postoperative differences in vertebral height were observed between the KP and VP groups. Similarly, KP was the only procedure that improved thoracic kyphosis in OVCF patients. Neither VP nor KP demonstrated significant improvement in sagittal balance, including pelvic parameters and the sagittal vertical axis. However, both groups showed marked pain relief, as evaluated by the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). Complication rates were low in both groups, and there was no significant difference in the incidence of cement leakage.

Conclusion: While both KP and VP demonstrated efficacy in treating OVCFs, neither procedure showed clear superiority in terms of pain relief, sagittal balance, or complication rates. However, only KP significantly increased vertebral height and improved thoracic kyphosis in OVCF patients.

Supplementary information: The online version contains supplementary material available at 10.1007/s43465-025-01438-x.