Vertebral infection after kyphoplasty: distinguishing misdiagnosis from true postoperative infection and implications for management
Abstract
Background: Spinal infection following percutaneous kyphoplasty (PKP) is rare but clinically devastating. However, its true incidence, diagnostic challenges, and optimal revision strategies remain poorly defined, particularly in referral-based cohorts.
Methods: We conducted a retrospective study comprising two components: (1) an institutional incidence analysis of 6,328 PKP procedures performed between 2015 and 2025, and (2) a pooled clinical cohort of 39 patients treated for post-PKP spinal infection, including 3 hospital-acquired cases and 36 referred cases. Patients were managed with either surgical (n = 27) or conservative (n = 12) strategies. Within the surgical group, a selective cement management approach (complete removal vs. partial retention) was applied based on intraoperative assessment. Clinical, microbiological, and radiographic data were analyzed descriptively. Functional outcomes were assessed using the Oswestry Disability Index (ODI).
Results: The institutional incidence of post-PKP infection was 0.05% (3/6328). In the pooled cohort (n = 39), the median age was 72 years, all patients presented with back pain, and fever was present in 20 patients. Potential etiologies included hematogenous spread, preoperative misdiagnosis, and iatrogenic factors. Eight cases of spinal tuberculosis were initially misdiagnosed as osteoporotic fractures. Microbiological confirmation was limited, with low culture positivity. Surgical management was associated with lower ODI…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 39 participants or records.
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