Which one is more effective for the treatment of very severe osteoporotic vertebral compression fractures: PVP or PKP?

Purpose: The purpose of this study was to compare the clinical efficacy and safety of percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in the treatment of the elderly with very severe osteoporotic vertebral compression fractures (vsOVCFs).

Methods: From September 2012 to September 2015, 57 patients with vsOVCFs who had undergone PVP and PKP surgeries at our medical center were reviewed retrospectively, at least 2 years follow-up. All patients were divided into PVP group (n=31) and PKP group (n=26). Clinical data including clinical and radiological evaluation results were performed pre- and postoperatively.

Results: The operation time of PVP group (29.6±3.3 minutes) was less than that of PKP group (37.4±4.2 minutes), with significant differences ( P <0.05). Compared with preoperative data, the VAS scores, Oswestry disability index (ODI) scores, and local kyphotic angle were improved with significant differences at 1 day after surgery and the last follow-up in two groups ( P <0.05). However, there were no differences in VAS and ODI scores between the two groups ( P >0.05). The local kyphotic angle of PVP group was more than that of PKP group after surgery, with significant differences ( P <0.05). At 1 day after surgery and the last follow-up, the anterior height of vertebrae fractured was significantly improved compared with preoperative in PKP group ( P <0.05), and there was no statistical difference compared with preoperative in PVP group ( P >0.05). However, there were no significant differences between the two groups in the leakage rate of bone cement ( P >0.05) and incidence of adjacent-level vertebra fracture ( P >0.05).

Conclusion: Both PVP and PKP can significantly relieve the pain of the patients with vsOVCFs. Restoring the vertebral height and local kyphotic angle corrections of PKP are comparatively better than those of PVP. However, the operation time of PKP is significantly longer than that of PVP and PKP is not superior in the leakage rate of bone cement and incidence of adjacent-level vertebra fracture compared to PVP.