Spine Journal - 2026-09-11 - Journal Article
Trends in Vertebral Augmentation in South Korea (2010-2024): A Nationwide Population-Based Study With International Comparison.
Lim DJ
Topics
Key Takeaway
South Korean vertebral augmentation volume nearly doubled over 15 years (30,190 to 59,556 procedures; AAPC +4.4%), driven by vertebroplasty growth to 91.3% market share, contrasting sharply with post-2009 US decline toward kyphoplasty predominance.
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Summary
This nationwide serial cross-sectional study used South Korean HIRA administrative codes to characterize vertebral augmentation utilization from 2010–2024. Vertebroplasty volume increased at AAPC +5.2% while balloon kyphoplasty declined nonsignificantly (AAPC -0.7%), and patients aged ≥80 years grew from an unspecified baseline to 54.3% of all cases by 2024 (AAPC +9.8%). Total adjudicated claim costs nearly doubled from KRW 9.679 billion to KRW 19.041 billion, with females consistently comprising 80–83% of annual volume.
Key Limitation
Aggregate HIRA data lack patient-level clinical variables—fracture severity, bone mineral density, prior conservative treatment duration, or outcomes—making it impossible to assess whether rising utilization reflects appropriate patient selection or overuse.
Original Abstract
BACKGROUND CONTEXT
Vertebral augmentation (VA)-vertebroplasty (VP) and balloon kyphoplasty (BKP)-treats painful osteoporotic vertebral compression fractures refractory to conservative care. After 2009 sham-controlled trials, US VA use declined and shifted toward BKP; long-term Korean trends are less defined.
PURPOSE
To evaluate national VA utilization in South Korea from 2010 through 2024 and compare it with international patterns.
STUDY DESIGN/SETTING
Nationwide serial cross-sectional study of public HIRA aggregate statistics (2010-2024).
PATIENT SAMPLE
Annual N0471 (VP) and N0473 (BKP) code-specific patient counts; the 15-year cumulative sum was 643,255. Counts could not be deduplicated across years or procedure categories.
OUTCOME MEASURES
Annual procedure, sex, age, regional, average annual percent change (AAPC), and nominal claim-amount trends.
METHODS
Descriptive summaries and log-linear regression were used; international comparisons were narrative. Funding was US$0; relevant financial relationships were US$0, and no study-specific conflict-of-interest-associated bias was identified.
RESULTS
The national annual count increased from 30,190 to 59,556 (+97.3%; AAPC +4.4%; p<0.001). VP rose from 24,165 to 54,364 (AAPC +5.2%; p<0.001), and its share increased from 80.0% to 91.3%. BKP ended 13.8% lower (6,025 to 5,192), with a nonsignificant trend (AAPC -0.7%; p=0.260). Females comprised 80.6%-82.6% of annual counts. The group aged 80 years or older reached 54.3% of counts in 2024 (AAPC +9.8%; p<0.001). Nominal HIRA-adjudicated claim amounts increased from KRW 9.679 billion to KRW 19.041 billion (+96.7%; AAPC +4.6%; p<0.001).
CONCLUSIONS
South Korea showed sustained VP-predominant growth, unlike US practice, and a marked shift toward patients aged 80 years or older, with planning implications in a super-aged society.