Clinical and radiological outcomes of hollow screw–percutaneous kyphoplasty in elderly patients with severe osteoporotic vertebral compression fractures

Abstract

Osteoporotic vertebral compression fracture (OVCF) significantly impacts the quality of life in the elderly population. Percutaneous kyphoplasty (PKP) is an effective procedure for pain relief and vertebral stabilization; however, severe OVCF has traditionally been considered a relative or even absolute contraindication for PKP. The screw–cement dual-load structure provides better axial load-bearing capacity. Therefore, this study aims to evaluate the safety and efficacy of hollow screw–percutaneous kyphoplasty (H-PKP), a novel bone cement–bridging hollow screw system, for the treatment of severe OVCF. A retrospective analysis was conducted on 86 cases of severe OVCF treated at our hospital between January 2019 and December 2023. Among these, 39 patients were in the H-PKP group, and 47 were in the PKP group. The baseline characteristics of the patients, as well as preoperative and postoperative VAS scores, Oswestry Disability Index (ODI), radiographic parameters, and general clinical outcomes, were collected. In addition, complications and adverse events were also recorded. All patients were followed up for at least 18 months postoperatively. At 24 h postsurgery, the VAS score in the H-PKP group was significantly higher than that in the PKP group (P = 0.032). However, at the final follow-up, the VAS and ODI scores in the H-PKP group were significantly lower than those in the PKP group (P = 0.030; P = 0.042). Kaplan–Meier curves demonstrated that the probability of achieving pain relief and functional recovery during follow-up was higher in the H-PKP group (P = 0.037; P = 0.029). Postoperatively, the H-PKP group showed greater improvements in anterior and middle vertebral heights than the PKP group (P = 0.014; P = 0.002). Additionally, the bisegmental Cobb angle improvement was greater in the H-PKP group than in the PKP group (P = 0.001). Both groups demonstrated some degree of vertebral height collapse postoperatively. At the final follow-up, the PKP group exhibited significantly greater anterior vertebral height (AVH) loss (P = 0.001) and bisegmental Cobb angle increase (P = 0.002) compared with the H-PKP group. For patients with severe OVCF, the H-PKP technique may represent a safe and effective treatment option. Compared with traditional PKP, H-PKP was associated with improved maintenance of vertebral height and more favorable long-term pain and functional outcomes during follow-up.