Infection Following Vertebroplasty or Kyphoplasty: A Systematic Review of Risk Factors, Treatment Options and Outcomes

Abstract

Study Design: Systematic Review. Objectives: Infection following vertebral augmentation using Percutaneous vertebroplasty (PV) and percutaneous balloon kyphoplasty (PBK) is an exceedingly rare, but potentially life-threatening complication. This systematic review evaluates the microbiological characteristics, risk factors, treatment strategies and outcomes of these infections. Methods: PubMed, Scopus, and Mendeley databases (2000-2025) were systematically reviewed. Inclusion criteria involved case cohorts of more than 5 adult patients with infections following PV or PBK. Data on the initial procedure, demographics, infection biomarkers, neurologic status, comorbidities, causative pathogens, treatment protocols, and outcomes were evaluated. Results: A total of 102 patients from 8 studies were included (mean follow-up: 22.9 months). Most were female (64.7%) with a mean age of 71.0 years (range: 50-95). The mean time interval from the initial procedure to infection diagnosis was 5.2 months (range: 0.03-85.2). The most common pathogen was Mycobacterium tuberculosis (35.3%). The mean infection biomarkers were CRP 36.77 mg/dL (range: 0.05-343), ESR 56.98 mm/h (range: 6-126), and WBC 8.53 cells/mm3 (range: 2.09-22.35). Seven patients (6.1%) were treated conservatively, while 95 patients (93.1%) underwent revision surgery. Outcomes were reported for 89 patients (87%). Final follow-up showed that 34 patients (38%) achieved normal mobility, 22 patients (25%) had assisted mobility (crutches or walker), and 11 patients (12%) required a wheelchair. The mobility status was unclear for 11 patients (12%). The mortality rate was 12.3%. Post-treatment mobility was strongly dependent on preoperative neurologic status (OR = 6.0, P = 0.001). Conclusions: Post-augmentation spinal infections are rare but serious. Outcomes are strongly influenced by preoperative neurological status, while pathogen type and patient comorbidities have limited prognostic impact.