A retrospective comparative study of traditional PVP and bone cement pedicle-anchored PVP techniques for stage I and II Kümmell's disease.

BACKGROUND

Kümmell’s disease (KD), characterized by delayed vertebral collapse with intravertebral vacuum cleft (IVC), remains controversial in clinical management. Traditional percutaneous vertebroplasty (PVP) may lead to cement loosening and vertebral re-collapse due to insufficient mechanical interlocking between cement and bone. This study compared the clinical efficacy of bone cement pedicle-anchored PVP (BCPA-PVP) versus conventional PVP for Stage I and II KD.

METHODS

A retrospective analysis enrolled 79 patients with Stage I/II KD undergoing PVP or BCPA-PVP between March 2018 and January 2023. Patients were divided into four groups: Stage I PVP (n=18), Stage I BCPA-PVP (n=20), Stage II PVP (n=20), and Stage II BCPA-PVP (n=21). Clinical outcomes, including Visual Analog Scale (VAS) scores, Oswestry Disability Index (ODI), anterior vertebral height (AVH), Cobb angle, and complications, were evaluated preoperatively, postoperatively (day 1), and at final follow-up.

RESULTS

For Stage I KD, no significant differences emerged between PVP and BCPA-PVP groups at final follow-up: VAS (1.06±0.66 vs. 0.90±0.64), ODI (15.33±3.24 vs. 15.60±4.76), AVH (26.94±2.29 mm vs. 27.10±2.45 mm), or Cobb angle (5.22±1.17° vs. 5.10±1.52°) (all P > 0.05). No cement loosening occurred. In Stage II KD, the PVP group showed significantly worse outcomes at final follow-up compared to BCPA-PVP: VAS (2.60±1.85 vs. 1.14±1.01, P < 0.05), ODI (30.40±12.67 vs. 19.52±9.84, P < 0.05), and AVH (20.15±2.64 mm vs. 21.86±1.72 mm, P < 0.05). Cement leakage occurred in 30.4% (24/79), with higher rates in Stage II BCPA-PVP (42.8%, 9/21). Cement loosening was observed exclusively in Stage II PVP group (25%, 5/20).

CONCLUSION

Conventional PVP can provide satisfactory outcomes for Stage I KD. However, BCPA-PVP is recommended for Stage II KD to reduce risks of cement loosening, vertebral re-collapse, and kyphotic progression.