Short-term gains, long-term pains: a comparative study of percutaneous vertebroplasty vs. kyphoplasty in osteoporotic vertebral compression fracture

Objective: To compare the clinical efficacy and long-term deformity correction retention of percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in the treatment of osteoporotic vertebral compression fractures (OVCF). Methods: We retrospectively analyzed clinical data from patients with OVCF admitted to our hospital between January 2020 and January 2023. Patients were allocated to either the PVP or PKP group. Baseline characteristics, intraoperative variables, deformity correction [anterior vertebral height (AVH) and local Cobb angle (CA)], and symptom relief [visual analog scale (VAS) scores for back pain] were compared. The incidence of bone cement leakage was assessed, and bone cement distribution patterns were compared between the procedures. In the PKP group, the correlation between cement distribution pattern and both deformity correction loss and symptom improvement were also analyzed. Results: Postoperatively, PKP demonstrated superior immediate anatomical restoration with greater AVH improvement (4.02 ± 0.34 mm vs. PVP 2.44 ± 0.21 mm, p = 0.005) and CA correction (-4.67° ± 0.32° vs. -3.02° ± 0.17°, p = 0.007). Both groups achieved comparable substantial symptom relief: median Oswestry Disability Index (ODI) decreased by 39.8 points in PVP and 39.7 points in PKP (p = 0.107), and median VAS decreased by 6.0 points in both groups (p = 0.420). However, at 2-year follow-up, PKP exhibited significant reversal: greater AVH correction loss (7.50% ± 0.97% vs. PVP 1.45% ± 0.57%, p < 0.001), CA correction loss (7.64% ± 1.12% vs. 1.10% ± 0.58%, p < 0.001), and worsened symptoms (VAS median 3.0 vs. 2.0, p =0.014; ODI 28.8% vs. 21.5%, p < 0.001). Critical to this divergence, PVP achieved superior cement distribution-reflected in higher Cement Distribution Score (CDS) (10.0 [IQR 9-10] vs. PKP 8.0 [8-9], p < 0.001) and Specific Surface Area (SSA) (5.66 ± 0.61 vs. 4.41 ± 0.67 cm²/cm³, p < 0.001)-with both parameters negatively correlating with loss of both AVH and CA correction, while positively correlating with improvement rates in VAS and ODI scores (all p < 0.001). PVP was associated with a significantly higher incidence of bone cement leakage compared to PKP (19.8% [20/101] vs. 8.42% [8/95], p = 0.024). PKP also incurred higher adjacent vertebral fractures (9.45% [9/95] vs. 1.98% [2/101], p = 0.023), augmented vertebra refractures (8.42% [8/95] vs. 1.98% [2/101], p = 0.041), longer operative time (44.15 ± 10.09 vs. 40.62 ± 11.71 min, p = 0.019), increased radiation exposure (24.26 ± 2.90 vs. 21.80 ± 3.35 exposures, p < 0.001), and doubled cost (8042 ± 1608 vs. 4316 ± 863 USD, p < 0.001). Conclusion: Both PVP and PKP are effective short-term treatments for OVCF. Therefore, PVP may be superior to PKP in maintaining long-term correction, particularly when bone cement distribution is optimized.