Related Experiment Video
Updated: Aug 13, 2026
Nine-Grid Area Division Method: A New Ideal Bone Puncture Region for Percutaneous Vertebroplasty in Lumbar Spine
Published on: August 9, 2024
Kyphoplasty for vertebral compression fractures: the blue zone effect
David Shin1, Elijah Haynal1, Rekha Isaac1
1School of Medicine, Loma Linda University, Loma Linda, CA, USA.
Background:
Kyphoplasty effectively treats vertebral compression fractures (VCFs) but carries risks of perioperative complications and readmissions. Blue zones, regions characterized by longevity and reduced chronic disease, provide a unique opportunity to examine how lifestyle factors may influence surgical outcomes. This study investigated how patient demographics, health status, surgical factors, and geographic location, particularly residence in a blue zone, affected kyphoplasty outcomes.
Methods:
A retrospective cohort review of 372 patients undergoing kyphoplasty for VCFs from January 2009 to May 2025 was conducted at a single, tertiary care institution. Patients were divided into blue zone or non-blue zone by postal codes. 1:3 propensity score matching (PSM) was used to minimize bias and multivariable logistic regression analyzed outcomes. A 10-year Kaplan-Meier survival curve was formulated utilizing a log-rank test.
Results:
A total of 190 patients (175 non-blue zone and 15 blue zone patients) were available after exclusion. In the unmatched cohort, tobacco usage was associated with higher 30-day readmissions. Increased length of stay (LOS) was associated with higher American Society of Anesthesiologists (ASA) scores, older age, diabetes, mechanical expansion, and greater estimated blood loss (EBL). Thoracolumbar involvement increased neurological complications, while a bilateral approach reduced incidence. Blue zone patients had significantly lower alcohol (0% vs. 34-64%) and tobacco use (7% vs. 43-47%) than non-blue zone patients in both unmatched and 1:3 PSM cohorts. No other significant differences in outcomes were observed.
Conclusions:
Our findings reinforce the significance of traditional risk factors including age, ASA score, diabetes, and tobacco use, as key indicators of kyphoplasty outcomes. Blue zone kyphoplasty patients demonstrated markedly healthier lifestyles, such as reduced alcohol and tobacco use. The present small-sized matched analyses demonstrated that while lifestyle and environmental factors may delay onset of chronic disease and VCF occurrence, no detectable association was identified between blue zone residence and kyphoplasty outcomes.
