Technical Adaptations in Kyphoplasty for T5 Vertebral Collapse With Sharp Kyphotic Angulation

Vertebral compression fractures (VCFs) are a common injury pattern observed in elderly individuals with osteoporosis. However, the presence of significant spinal deformity and/or advanced vertebral collapse can render kyphoplasty technically challenging. We present the case of a 65-year-old woman suffering from severe osteoporosis who experienced a T5 compression fracture attributed to a pronounced thoracic kyphosis and osteoporosis, with approximately 75% reduction in vertebral height. Despite initial conservative management, the patient's pain persisted. During the procedure, the concave geometry of the collapsed vertebrae posed considerable access challenges, necessitating a transition from the originally planned straight-needle trajectory to a curved-needle approach. This adaptation facilitated safe navigation through the altered anatomy, enabling balloon deployment and cement augmentation. The patient reported complete cessation of pain postoperatively, with continued relief observed at follow-up. This case highlights the importance of curved instrumentation in overcoming complex anatomical constraints, thereby minimizing procedural risks and enhancing outcomes in intricate osteoporotic VCFs.