Disadvantages of balloon kyphoplasty with PMMA - A clinical and biomechanical statement

Balloon kyphoplasty (BKP) and vertebroplasty (VP) are clinically effective procedures. However, BKP has been occasionally associated with failure, although the cause has not been established thus far. We believe that, especially in patients with severe osteoporosis and osteonecrosis, BKP fails due to the so-called stress shielding effect and the stiffness of cement. In these patients, other bone-preserving kyphoplastic procedures and vertebroplasty, as well as recently introduced cements adjusted to the severity of osteoporosis, might be benefi cial. Furthermore, it is essential to achieve complete straightening intraoperatively when performing BKP, because any persistent residual kyphosis will aggravate the burden on the adjacent vertebral bodies following the creation of a cavity fi lled with cement. Therefore, it would be meaningful to consider alternative bone-preserving kyphoplastic measures instead of BKP. In cases of older fractures, one should consider the use of VP and the recently introduced cements.