Balloon Kyphoplasty Is Unable to Improve Low Health-Related Quality of Life in Imbalanced Patients: A Longitudinal Cohort Study

Abstract

Abstract Introduction: Osteoporotic vertebral compression fracture (OVCF) is a major public health concern, affecting the quality of life (QOL) of patients, particularly older adults. Balloon kyphoplasty (BKP) is a minimally invasive surgical treatment for OVCFs, with good clinical outcomes reported in short-term investigations. However, the impact of BKP on health-related QOL in the long term remains unclear. This study aimed to evaluate the effects of BKP on global sagittal balance and alignment and to determine the association between predictive factors before BKP and health-related QOL in the long term. Methods: A longitudinal cohort study was conducted on 62 patients (13 men and 49 women) diagnosed with OVCF who underwent BKP and were followed up for more than 12 months. Spinopelvic parameters, including sagittal vertical axis (SVA), thoracic kyphosis (TK), pelvic incidence (PI) minus lumbar lordosis (LL), and low back pain (LBP) severity, were measured preoperatively, at 3 months post-BKP, and at final follow-up. Multivariate logistic regression analysis was performed to identify predictive factors for unhealthy condition after BKP, with adjustment for age, sex, and duration from onset of back pain to BKP. Results: The mean follow-up duration was 20.7 months. The mean SVA values were 7.42 cm preoperatively, 7.62 cm at 3 months post-BKP, and 8.01 cm at final follow-up. The mean self-reported numerical rating scale scores for LBP were 8.4 preoperatively, 0.4 post-BKP, 0.6 at 3 months post-BKP, and 1.0 at final follow-up. Imbalanced spine (SVA ≥ 5.0 cm) and PI-LL mismatch (PI-LL ≥ 20°) before BKP were significantly associated with unhealthy condition (EuroQol 5 dimensions 5-level < 0.65) (odds ratio and 95% confidence intervals: imbalanced spine, 4.76 and 1.32–17.2; PI-LL mismatch, 3.78 and 1.18–12.1, respectively). Conclusions: BKP did not improve global spinopelvic parameters or health-related QOL in imbalanced patients. Higher SVA measurements and PII-LL mismatch before BKP were associated with lower health-related QOL after BKP. Therefore, BKP for imbalanced patients did not improve low health-related QOL.