Technical Limitations and Implant Developments in Percutaneous Kyphoplasty for Osteoporotic Vertebral Compression Fractures

As a core minimally invasive technique for treating osteoporotic vertebral compression fracture (OVCF), percutaneous kyphoplasty (PKP) is widely employed clinically but continues to face significant technical challenges. These include uneven cement distribution, loss of vertebral height reduction, cement leakage, and adjacent vertebral re-fractures. To overcome these limitations, multi-dimensional technical refinements have emerged in recent years: innovations in surgical access and propping instruments (e.g., percutaneous curved kyphoplasty (PCKP), Sky system) optimize cement spatial distribution; intravertebral support implants (e.g., SpineJack, vertebral body stenting [VBS], stabilizing augmented Intervertebral Force [SAIF]) provide sustained mechanical support and mitigate loss of reduction height; and cement flow control techniques (e.g., Bone-filled bag systems, Kiva system), coupled with the use of high-viscosity bone cement, have significantly reduced leakage risks. This paper systematically reviews recent advancements in propping technology and intravertebral implants addressing these PKP challenges, aiming to provide an evidence-based foundation for optimizing the minimally invasive management of OVCF. Future development requires bioactive bone cements (e.g., magnesium/calcium phosphate-based composites) integrated with precise personalized design to advance PKP toward facilitating physiological bone remodeling.