Skip to main content
JDRS · Open access journal
Joint Diseases and
Related Surgery
Online manuscript submissionSubmit a manuscript e-ISSN 2687-4792

Original Article · Open access

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

PDF Cite this article

Dong-zhe Li

Department of Orthopedics Surgery, West China School of Medicine, Sichuan University, Sichuan University affiliated Chengdu Second People’s Hospital, Chengdu Second People’s Hospital, Chengdu, China

ORCID: 0000-0001-6148-6807

Yu He

Department of Orthopedics Surgery, West China School of Medicine, Sichuan University, Sichuan University affiliated Chengdu Second People’s Hospital, Chengdu Second People’s Hospital, Chengdu, China

ORCID: 0000-0002-3854-1801

Zhao-kui Yan

Department of Orthopaedics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China

ORCID: 0009-0001-1040-2551

Tai-ping Wang

Department of Orthopedics Surgery, West China School of Medicine, Sichuan University, Sichuan University affiliated Chengdu Second People’s Hospital, Chengdu Second People’s Hospital, Chengdu, China

ORCID: 0009-0006-0147-7080

Yong Zeng

Department of Orthopedics Surgery, West China School of Medicine, Sichuan University, Sichuan University affiliated Chengdu Second People’s Hospital, Chengdu Second People’s Hospital, Chengdu, China

ORCID: 0009-0000-5370-7745

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.

Declarations

Author Contributions

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.

Conflict of Interest

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

Financial Disclosure

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

Data Sharing Statement

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

AI Disclosure

The authors declare that artificial intelligence (AI) tools were not used, or were used solely for language editing, and had no role in data analysis, interpretation, or the formulation of conclusions. All scientific content, data interpretation, and conclusions are the sole responsibility of the authors. The authors further confirm that AI tools were not used to generate, fabricate, or ‘hallucinate’ references, and that all references have been carefully verified for accuracy.

References

  1. Zhang T, Peng Y, Li J. Comparison of clinical and radiological outcomes of vertebral body stenting versus percutaneous kyphoplasty for the treatment of osteoporotic vertebral compression fracture: A systematic review and metaanalysis. Jt Dis Relat Surg 2024;35:218-30. DOI: 10.52312/jdrs.2023.1356.
  2. Dai C, Liang G, Zhang Y, Dong Y, Zhou X. Risk factors of vertebral re-fracture after PVP or PKP for osteoporotic vertebral compression fractures, especially in Eastern Asia: A systematic review and meta-analysis. J Orthop Surg Res 2022;17:161. DOI: 10.1186/s13018-022-03038-z.
  3. Al Taha K, Lauper N, Bauer DE, Tsoupras A, Tessitore E, Biver E, et al. Multidisciplinary and coordinated management of osteoporotic vertebral compression fractures: Current state of the art. J Clin Med 2024;13:930. DOI: 10.3390/jcm13040930.
  4. Beall DP, Phillips TR. Vertebral augmentation: An overview. Skeletal Radiol 2023;52:1911-20. DOI: 10.1007/s00256-022-04092-8.
  5. Buchbinder R, Johnston RV, Rischin KJ, Homik J, Jones CA, Golmohammadi K, et al. Percutaneous vertebroplasty for osteoporotic vertebral compression fracture. Cochrane Database Syst Rev 2018;4:CD006349. DOI: 10.1002/14651858.CD006349.pub3.
  6. Yang H, Liu H, Wang S, Wu K, Meng B, Liu T. Review of percutaneous kyphoplasty in China. Spine (Phila Pa 1976) 2016;41:B52-8. DOI: 10.1097/BRS.0000000000001804.
  7. Cai D, Zhang B, Li J, Wang P, Tao X. Clinical effect of percutaneous kyphoplasty and percutaneous vertebroplasty in managing osteoporotic vertebral compression fractures: A single-center propensity score-matched study. Ann Ital Chir 2024;95:848-58. DOI: 10.62713/aic.3634.
  8. Lv B, Ji P, Fan X, Yuan J, Xu T, Yao X, et al. Clinical efficacy of different bone cement distribution patterns in percutaneous kyphoplasty: A retrospective study. Pain Physician 2020;23:E409-16.
  9. Yang K, Zhu X, Sun X, Shi H, Sun L, Ding H. Bone cement distribution patterns in vertebral augmentation for osteoporotic vertebral compression fractures: A systematic review. J Orthop Surg Res 2025;20:568. DOI: 10.1186/s13018-025-05868-z.
  10. Yang R, Huang Z, Shao S, Liu J, Xia S, Li W, et al. Comparison of unilateral and bilateral robot-assisted percutaneous kyphoplasty in treating osteoporotic vertebral compression fracture. World Neurosurg 2025;197:123911. DOI: 10.1016/j.wneu.2025.123911.
  11. Sun H, Li C. Comparison of unilateral and bilateral percutaneous vertebroplasty for osteoporotic vertebral compression fractures: A systematic review and metaanalysis. J Orthop Surg Res 2016;11:156. DOI: 10.1186/s13018-016-0479-6.
  12. Bakhsheshian J, Dahdaleh NS, Fakurnejad S, Scheer JK, Smith ZA. Evidence-based management of traumatic thoracolumbar burst fractures: A systematic review of nonoperative management. Neurosurg Focus 2014;37:E1. DOI: 10.3171/2014.4.FOCUS14159.
  13. Zhao H, Ren K, Dong X, Liao B. The clinical efficacy of percutaneous vertebroplasty combined with postural reduction versus kyphoplasty: A systematic review and meta-analysis. J Back Musculoskelet Rehabil 2025;38:655-61. DOI: 10.1177/10538127241296690.
  14. Hambrecht J, Köhli P, Duculan R, Chiapparelli E, Lan R, Guven AE, et al. The disaggregated oswestry disability index: What is the most predictive subsection for patient satisfaction after lumbar surgery? Spine (Phila Pa 1976) 2025;50:E308-13. DOI: 10.1097/BRS.0000000000005154.
  15. Chu W, Tsuei YC, Liao PH, Lin JH, Chou WH, Chu WC, et al. Decompressed percutaneous vertebroplasty: A secured bone cement delivery procedure for vertebral augmentation in osteoporotic compression fractures. Injury 2013;44:813-8. DOI: 10.1016/j.injury.2012.10.017.
  16. Chang X, Lv YF, Chen B, Li HY, Han XB, Yang K, et al. Vertebroplasty versus kyphoplasty in osteoporotic vertebral compression fracture: A meta-analysis of prospective comparative studies. Int Orthop 2015;39:491- 500. DOI: 10.1007/s00264-014-2525-5.
  17. Wang Q, Sun C, Zhang L, Wang L, Ji Q, Min N, et al. High- versus low-viscosity cement vertebroplasty and kyphoplasty for osteoporotic vertebral compression fracture: A meta-analysis. Eur Spine J 2022;31:1122-30. DOI: 10.1007/s00586-022-07150-w.