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

Abstract

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. 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. 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. 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.