Efficacy and complications of different surgical modalities of treating osteoporotic spinal compression fracture in the elderly

Purpose: To explore the efficacy and complications of different surgical modalities in the treatment of osteoporotic spinal compression fractures (OSCFs) in the elderly. Methods: This retrospective study included 98 elderly patients with OSCFs who received surgical treatment in the Changsha Hospital of Traditional Chinese Medicine from March 2018 to July 2020. Based on different surgical treatments, the patients were divided into a percutaneous kyphoplasty (PKP) group (n=51) and a percutaneous vertebroplasty (PVP) group (n=47). The intraoperative blood loss, operation time, the amount of bone cement per vertebral body, length of hospitalization, and fracture healing time were recorded and compared between the two groups. The original anterior wall height and middle height of the compressed fractured vertebra were then evaluated and compared at 3 time points, namely before operation, 2 days after operation, and 6 months after operation. Pain, spinal function improvement and Cobb's angle were evaluated and compared between the two cohorts of patients before operation and 3 months after operation. Adverse reactions and bone cement permeability were recorded and compared between the two groups. Patients' quality of life quality was evaluated using the 36-Item Short-Form Health Survey (SF-36) before treatment and 12 months after treatment. Treatment satisfaction was evaluated. Results: Intraoperative blood loss, the average use of bone cement per vertebral body and length of hospitalization were similar between the groups (P>0.05). However, the PKP group had significantly longer operation time and fracture healing time than the PVP group (P<0.05). Vertebral 3D volume, as well as anterior wall and middle vertebra heights increased significantly at 6 months after surgery in both groups (all P<0.05). In addition, anterior wall and middle vertebra heights increased more in the PVP group than in the PKP group. The Visual Analogue Scale (VAS) and Oswesrty Disability Index (ODI) scores, as well as Cobb's angle decreased in both groups at 3 months after treatment (all P<0.05). The Cobb's angle and VAS score of the PVP group showed more significant reductions (all P<0.05). The PKP group had a higher incidence of adverse reactions and bone cement leakage rate than the PVP group (all P<0.05). However, no distinct difference was determined between the two groups in terms of patients' quality of life at 12 months after surgery. Treatment satisfaction was significantly higher in the PVP group than the PKP group. Conclusion: For the treatment of senile OSCFs, both PVP and PKP have the advantages of little trauma and quick recovery. PVP has an edge over PKP with significantly shorter operation time, lower possibility of bone cement venous leakage and adjacent cone fracture, and higher surgical safety.