Evaluating the effect of early balloon kyphoplasty on adjacent vertebral fracture risk in osteoporotic vertebral fracture management: a retrospective study

STUDY DESIGN: Retrospective cohort study. PURPOSE: To evaluate whether the timing of balloon kyphoplasty (BKP) affects the risk of adjacent vertebral fractures (AVFs) in the management of osteoporotic vertebral fractures. OVERVIEW OF LITERATURE: Osteoporotic vertebral fractures are usually managed conservatively; however, complications such as nonunion, neurologic deficits, and high-grade kyphosis can arise. BKP, a minimally invasive procedure for pain relief, has been associated with AVF risk. Although meta-analyses suggest no significant difference in AVF rates between BKP and conservative treatment, retrospective studies report higher AVF rates after BKP. Many of these cases involve patients resistant to conservative treatment, which implies that differences in the incidence of AVF may be influenced by the delay before performing BKP. METHODS: We retrospectively analyzed 189 patients who underwent BKP between 2012 and 2023, excluding those with pathological fractures. The incidence of AVF was assessed at 3 months after BKP. Risk factors, including age, sex, fracture site, prior vertebral fractures, bone mineral density, kyphosis angle, endplate damage, signal changes in the fractured vertebral body on magnetic resonance imaging, vertebral instability, and timing of BKP, were evaluated. RESULTS: The overall incidence of AVFs was 29%. The AVF rate was 21% in patients treated with BKP within 30 days, as compared with 32% in those treated later; however, this difference was not statistically significant (p =0.15). Multivariate analysis identified vertebral instability as the only significant risk factor for AVF (odds ratio, 2.73; p =0.01), whereas the timing of BKP showed no significant association with AVF risk. CONCLUSIONS: Early BKP does not significantly reduce the risk of AVF. The findings suggest that the management of osteoporotic vertebral fractures should focus on vertebral stability rather than intervention timing.