Manual reduction combined with percutaneous vertebroplasty versus percutaneous kyphoplasty for the treatment of osteoporotic vertebral compression fractures

Abstract

Objectives: This study aims to compare manual reduction combined with percutaneous vertebroplasty (PVP) versus percutaneous kyphoplasty (PKP) for the treatment of fresh (≤ 3 weeks post-injury), single-segment osteoporotic vertebral compression fractures (OVCFs).

Patients and methods: Between January 2021 and January 2024, a total of 136 patients (46 males, 90 females; mean age: 76.8 ± 8.4 years; range, 60 to 94 years) with thoracolumbar OVCFs who underwent vertebral augmentation were retrospectively analyzed. The patients were assigned to either Group 1 (manual reduction + PVP, n = 60) or Group 2 (PKP alone, n = 76). Operative time, fluoroscopy frequency, cement volume, cement leakage, cement distribution, anterior vertebral height (AVH), kyphotic Cobb angle, and Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores were compared.

Results: Compared to Group 2, Group 1 showed significantly shorter operative time (29.2 ± 5.1 min vs. 32.4 ± 8.2 min, p < 0.05), fewer intraoperative fluoroscopy scans (18.9 ± 1.7 vs. 21.9 ± 3.0, p < 0.05), greater cement volume (4.9 ± 0.8 mL vs. 4.0 ± 0.7 mL, p < 0.05), and a higher proportion of favorable cement distribution (80.0% vs. 56.6%, p < 0.05). Cement leakage rates were comparable (21.7% vs. 18.4%, p > 0.05). Although preoperative parameters were similar between the groups, Group 1 achieved significantly better postoperative AVH (23.1 ± 2.2 mm vs. 20.4 ± 2.6 mm, p < 0.05), kyphotic Cobb angle (8.5 ± 1.9° vs. 10.6 ± 1.9°, p < 0.05), and ODI scores (19.0 [18.0, 21.0] vs. 21.0 [19.0, 23.0], p = 0.001) compared to Group 2. Postoperative VAS scores showed no significant difference between the groups (2.0 [2.0, 3.0] vs. 2.0 [2.0, 3.0], p = 0.354). Both groups exhibited significant postoperative improvements in all clinical outcomes (p < 0.05).

Conclusion: Although both techniques effectively relieve pain and correct deformity, manual reduction combined with PVP offers more favorable radiographic restoration, improved functional outcomes, shorter operation time, and less radiation exposure compared to PKP.

Citation: Li DZ, He Y, Yan ZK, Wang TP, Zeng Y. Manual reduction combined with percutaneous vertebroplasty versus percutaneous kyphoplasty for the treatment of osteoporotic vertebral compression fractures. Jt Dis Relat Surg 2026;37(2):381- 389. doi: 10.52312/jdrs.2026.2652.

D.Z.L., Z.K.Y., T.P.W.: Conception and design; D.Z.L., Y.H.: Collection and assembly of data; D.Z.L.: Analysis and interpretation of the data, drafting of the article; Y.H.: Statistical expertise; Y.Z.: Critical revision of the article for important intellectual content. All authors read and approved the final manuscript.

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

The authors received no financial support for the research and/or authorship of this article.

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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