Comparing Percutaneous Kyphoplasty Outcomes in Very Severe Osteoporotic Vertebral Compression Fractures Across Distinct Spinal Segments: Upper/Middle Thoracic versus Thoracolumbar

Jin Liu; Bin Xia; Simin Xie; Yiteng Zhang; Wengang Wang; Jing Tang

doi:10.1016/j.wneu.2025.124630

Comparing Percutaneous Kyphoplasty Outcomes in Very Severe Osteoporotic Vertebral Compression Fractures Across Distinct Spinal Segments: Upper/Middle Thoracic versus Thoracolumbar

World Neurosurg. 2025 Nov 6:205:124630. doi: 10.1016/j.wneu.2025.124630. Online ahead of print.

Authors

Jin Liu¹, Bin Xia¹, Simin Xie¹, Yiteng Zhang², Wengang Wang¹, Jing Tang³

Affiliations

¹ Department of Orthopedics, Chengdu Seventh People's Hospital, Chengdu, China.
² Department of Radiology, Sichuan University West China Hospital, Chengdu, China.
³ Department of Radiology, Sichuan University West China Hospital, Chengdu, China. Electronic address: tangjing@wchscu.cn.

PMID: 41205867
DOI: 10.1016/j.wneu.2025.124630

Abstract

Objective: To comparatively evaluate therapeutic outcomes and complications of percutaneous kyphoplasty (PKP) treatment for very severe osteoporotic vertebral compression fractures (vsOVCF) located in different segments, providing evidence-based recommendations for anatomical region-specific management.

Methods: Data of patients over 65 years old with vsOVCF, located in T5-L3 segments treated by PKP in our hospital during April 2015 and December 2021, were retrospectively analyzed. Fractures were stratified by anatomical location: upper/middle thoracic and thoraco/lumbar cohorts. Symptom improvement, imaging index changes, and complications were compared.

Results: This study included 79 patients (mean age 77.1 ± 6.4 years, 65 women) with vsOVCFs stratified by location: upper/middle thoracic (T5-T9, n = 22) and thoraco/lumbar (T10-L3, n = 57). The preoperative visual analog scale score of the upper/middle thoracic group was higher than that of the thoraco/lumbar group. But there was no significant difference in postoperative visual analog scale and Eastern Cooperative Oncology Group score at the last follow-up or height improvement between the 2 groups (P > 0.05). The thoraco/lumbar group exhibited significantly higher rates of low-energy injury and intravertebral clefts preoperatively (P < 0.05). Vertebral height was significantly lower postoperatively in the upper/middle thoracic group (P < 0.05), but comparable at final follow-up. The thoraco/lumbar group demonstrated significantly greater local kyphotic angle and a 4.4-fold higher recollapse rate (P < 0.05) at final follow-up. New fracture incidence was borderline higher in the thoraco/lumbar group (17 vs. 2 fractures, P = 0.053). Bone cement leakage showed no intergroup difference.

Conclusions: PKP provides significant pain relief and functional improvement in vsOVCF, regardless of the lesion's location. However, thoraco/lumbar vsOVCF demonstrate substantially higher risk of augmented vertebral recollapse after PKP.

Keywords: Clinical outcome; Complications; Osteoporosis; Percutaneous kyphoplasty; Recollapse; Very severe osteoporotic vertebral compression fractures.