Vertebroplasty vs. Balloon Kyphoplasty for Vertebral Compression Fractures: A 331-Patient Experience

Objective: Vertebral augmentation with percutaneous vertebroplasty (PVP) or balloon kyphoplasty (BKP) is widely used for painful vertebral compression fractures (VCFs), yet examining that examining single-center outcomes across mixed etiologies remains informative. Methods: We retrospectively analyzed 331 consecutive patients treated with PVP (n=155) or BKP (n=176). Mean age was 57.2 years, and 202 participants (61.0%) were women. Overall, etiologies were traumatic: 166 (50.2%) and osteoporotic: 165 (49.8%); men predominantly had traumatic fractures (101/129), whereas women predominantly had osteoporotic fractures (137/202). The primary endpoint was early pain change [Visual Analog Scale (VAS)]. Safety endpoints included radiographic/symptomatic cement leakage, new/adjacent symptomatic fractures, cardiopulmonary events, infection, and reoperation for progressive kyphosis. Results: Mean VAS improved from 8.23±0.82 to 3.03±1.60 at early follow-up (Δ-5.19, p<0.001). Radiographic cement leakage occurred in 13/331 (3.9%); with 1/331 (0.3%) of these cases being symptomatic. New/adjacent symptomatic VCFs occurred in 24/331 (7.2%). Other complications were infrequent: pulmonary embolism occurred in 3 out of 331 cases (0.9%), myocardial infarction in 1 out of 331 cases (0.3%), and infection in 1 out of 331 cases (0.3%). Reoperation for progressive kyphosis (posterior instrumentation and fusion) was required in 17/331 (5.1%) (4 men, 13 women). Outcomes were favorable across both techniques, with choice individualized by fracture morphology and alignment goals. Conclusion: In this large, single-center experience, vertebral augmentation provided rapid, clinically meaningful pain relief with low symptomatic complication rates and modest new fracture incidence. The observed 5.1% reoperation rate underscores the need for longitudinal alignment surveillance and aggressive osteoporosis management. Findings support selection-driven use of PVP or BKP with meticulous cement management and structured follow-up.