Early Percutaneous Kyphoplasty Is Associated with Reduced Risk of Subsequent Thoracic Vertebral Compression Fracture

Although percutaneous kyphoplasty (PKP) is widely recognized as an effective treatment for osteoporotic vertebral compression fractures (VCFs), there is growing concern about the risk of subsequent VCF after the procedure. Prior studies suggest that the timing between primary VCF and PKP may affect future VCF, but there are limited data evaluating this timing, and no studies use data-driven methods to derive precise thresholds. Therefore, the aim of this study was to determine (1) the optimal time interval that minimizes the risk of 2-year subsequent VCF and (2) the impact of this interval on 90-day medical complications after PKP.

A retrospective cohort analysis in patients who underwent PKP for primary thoracic VCF from 2010 to 2022 was identified using a national administrative claims database. Stratum-specific likelihood ratio (SSLR) analysis was conducted to determine data-driven timing strata between primary thoracic VCF and PKP that minimized the likelihood of subsequent VCF within 2 years of the index PKP procedure. To control for confounders, multivariable regression analysis was conducted to confirm the identified data-driven association with 2-year VCF rates and compare the likelihood of various 90-day medical complications.

In total, 16,197 patients who underwent PKP after primary VCF were included in this study. SSLR analysis identified two timing thresholds: 0 weeks (same day cohort) and 1 to 30 weeks (Delayed cohort). The same day cohort was significantly less likely to experience 2-year subsequent VCF than was the Delayed cohort (odds ratios: 0.52; 95% confidence interval: 0.47-0.56; p<0.001).

Early PKP significantly reduces the risk of 2-year subsequent VCFs compared with delayed intervention by nearly 50%. During this preoperative period, patient optimization should be prioritized to enhance management outcomes, allowing a careful balance between timely intervention and comprehensive patient evaluation.