Balloon kyphoplasty (BK) and vertebroplasty (VP) are two minimally invasive augmentation techniques that have been critically scrutinised since 2009 following two articles that raised doubts in the scientific community (sham control studies). Consequently, the number of procedures performed has declined in the following few years, even leading to reduced survival of patients. Five-year follow-up of patients in 2009 was associated with an increased risk of mortality [7].

Subsequent studies have proven the effectiveness of both augmentation methods, and recommendations again classify them as effective methods for the treatment of acute fracture pain, chronic pain, and a proven increase in the quality of life of an elderly person with a fracture. In contrast to non-surgical treatment, BK is more effective in reducing pain, “back-related disability”, and improving quality of life [8].

BK is a minimally invasive surgical procedure for the treatment of pain and correction of the kyphotic angle in osteoporotic fractures of type A1 and A2. Two inflatable balloons, introduced transpedicular, are used to correct the vertebral deformity and to fill the fracture fissures or the cavity created by the inflated balloon in the vertebra with cement (“eggshell” technique). The available literature focuses on the “pain killing” effect, and the elderly person is generally able to stand upright on their own for a few hours after the procedure, without any significant pain. Indications for BK are:

Unbearable pain from an acute fracture of the thoracic or lumbar spine.

A tendency for continuous vertebral collapse and additional loss of height, visible on standing radiographs.

Persistence of acute pain for weeks after the fracture; some authors take three weeks as the limit, whereas others use six to twelve.

In osteoporotic fractures, it is sometimes difficult to distinguish a fresh fracture from previous chronic lesions and acute fracture pain from other medical causes, so routine MRI of the spine is advised before BK.

Vertebroplasty (VP) is an augmentation method where cement is also injected transpedicular into the fractured vertebral body, but without inflatable balloons; however, the Cobb angle of kyphosis is not corrected as much as in BK. Some authors consider VP as a developmental precursor of BK.

Both methods have described complications, such as extravasation of cement through fracture fissures from the vertebral body into adjacent anatomical structures (spinal canal, vena cava, aorta), compression of neurological structures, and venous embolisms. The “eggshell” technique often avoids these complications in BK. Comparison of late results one year after VP and BK revealed that the fracture of the adjacent vertebra occurs according to the progression of osteoporosis and according to the biomechanics of kyphosis. By both methods, adjacent vertebral fracture represents a rare complication, with no statistically significant differences in incidence. The results of the studies show that adjacent vertebral fracture is likely even without an adjacent vertebral augmentation procedure. Both methods offer comparable pain reduction [9].

Balloon kyphoplasty is preferred for fractures with more than 50% loss of vertebral height, as it allows for greater vertebral height restoration and improved alignment. In contrast, vertebroplasty is preferred for fractures with less than 50% loss of vertebral height.

Recent studies have shown that both vertebroplasty and balloon kyphoplasty are safe and effective procedures for selected patients with osteoporotic thoracolumbar spinal fractures associated with significant improvements in pain relief, mobility, and quality of life compared to conservative treatment.

Minimally invasive techniques such as vertebroplasty and balloon kyphoplasty offer several advantages over traditional open surgical procedures. These procedures can be performed under local anaesthesia and conscious sedation, avoiding the risks associated with general anaesthesia. They also involve smaller incisions, reducing the risk of postoperative complications such as wound infection and bleeding. Moreover, these procedures can be performed as outpatient procedures, allowing patients to return home on the same day.