The effect of time to balloon kyphoplasty on osteoporotic vertebral compression fractures: a systematic review with meta-analysis

Background: Vertebral compression fractures (VCFs) cause significant morbidity in the elderly population. This study aimed to determine the difference in pain-related outcomes in the elderly population who suffered vertebral body fractures, treated with balloon kyphoplasty at "early" (<4 weeks) and "late" (>4 weeks) stages. To the best of our knowledge, this has not been previously evaluated in a meta-analysis. Methods: We conducted a systematic literature review as per PRISMA guidelines using databases that included PubMed, EMBASE, Cochrane and Scopus. The search included adults (age 19+) who sustained osteoporotic vertebral compression fractures that were treated with BKP, grouped by time to intervention as compared to conservative treatment to determine impact on radiographic and clinical outcomes. Results: A total of 9 studies were included from a total of 139 screened records eligible for title and abstract screening after deduplication (39 PubMed, 85 EMBASE, 6 Cochrane, 50 Scopus). The total study sample size was 595. Of these, 6 studies defined their "Early" group as < 4 weeks and were included in our sub-analyses. In regard to pain scores we found a significant improvement in pain score in the early vs. late group. However, we did not find a significant correction in kyphotic correction. Conclusions: Our study suggests that early treatment of vertebral compression fractures with Balloon Kyphoplasty (BKP), defined as < 4 weeks, provides a statistically significant improvement in pain scores and kyphotic angle correction compared to late treatment (>4 weeks). However, no statistically significant differences were observed in terms of height restoration or the risk of adjacent level fractures. These findings support the benefits of early intervention for pain relief and alignment, though further research is needed to standardize methodologies and assess long-term outcomes.