🎈 Balloon Kyphoplasty (BKP)

Balloon kyphoplasty (BKP) is a minimally invasive spine procedure used to treat painful vertebral compression fractures (VCFs), most commonly caused by osteoporosis, trauma, or spinal metastases.

1. Access: A small cannula is introduced into the fractured vertebra under fluoroscopic guidance.
2. Balloon Inflation: An orthopedic balloon (bone tamp) is inserted and inflated to:
   • Elevate the collapsed vertebra
   • Restore vertebral height
   • Create a cavity for cement
3. Cement Injection: After balloon removal, bone cement (typically PMMA) is injected into the cavity to stabilize the fracture.

• Rapid pain relief
• Restoration of vertebral body height
• Correction of kyphotic deformity
• Improved patient mobility and quality of life

• Acute or subacute osteoporotic vertebral compression fractures
• Persistent pain not responding to conservative therapy
• Vertebral collapse due to metastatic disease
• Select cases of traumatic vertebral fractures without posterior wall compromise

• Cement leakage (less frequent than vertebroplasty)
• Adjacent vertebral fractures
• Infection or bleeding
• Rare neurological complications

In a case report by Tanaka et al., published in Cureus in May 2025, and authored by clinicians from the Departments of Neurosurgery at the International University of Health and Welfare Narita Hospital (Narita), Shiroishi Kyoritsu Hospital (Shiroishi), Shojima Neurosurgery (Saga), Imari Arita Kyoritsu Hospital (Arita), and the Department of Neurology at Shiroishi Kyoritsu Hospital, the authors describe the management of an 87-year-old patient with a cascade of adjacent osteoporotic vertebral fractures. The purpose of the report is to highlight the role of early and repeated balloon kyphoplasty (BKP) as an effective bridging strategy to preserve mobility, spinal alignment, and independence in super-aged patients, until the delayed therapeutic effects of pharmacologic osteoporosis treatments, such as teriparatide, become evident ¹⁾

1. Overinterpretation of a Single Case

The fundamental flaw of this report is its excessive generalization from a single anecdotal case. No matter how long the follow-up, one patient’s trajectory cannot justify broad clinical recommendations, especially regarding a high-cost and procedure-intensive strategy like repeated BKP.

2. Lack of Scientific Rigor

There is no control, no comparative data, no validated outcome measures, and no quantitative metrics for quality of life, ADLs, or pain levels. Terms like “preserved mobility” or “restored independence” are qualitative and vague, lacking any reproducible or measurable endpoints.

3. Ignored Risks of Repeat BKP

While the authors promote early BKP after each fracture, they fail to critically engage with the well-known risks of repeated vertebral augmentation: cement leakage, adjacent segment disease, spinal rigidity, and procedural complications in frail, super-aged patients.

4. Absence of Pharmacologic Context

The report calls BKP a “bridge” to teriparatide efficacy, yet no pharmacokinetic or bone density data are presented to demonstrate when or if the drug began to work. There’s no discussion of vitamin D status, compliance, or any other antiresorptive/osteoanabolic strategy, making the so-called “bridge” conceptually empty.

5. Cureus Syndrome

As with many Cureus publications, the article lacks peer-reviewed robustness, and appears more as a personal narrative than a scholarly contribution. The journal's low threshold for acceptance and focus on volume over rigor is once again evident in this publication.

🧠 Bottom Line for Neurosurgeons:

This report may be useful as a cautionary tale, not a treatment paradigm. It illustrates the real-world desperation in managing elderly patients with osteoporosis—but provides no credible evidence to support repeated BKP as a viable clinical standard. Until proper comparative studies exist, this case should be interpreted as what it is: a well-intentioned anecdote wrapped in unjustified optimism.