Comparison between Percutaneous Kyphoplasty and Posterior Fixation Combined with Vertebroplasty in the Treatment of Stage III Kümmell's Disease without Neurological Deficit

OBJECTIVE: To evaluate the clinical and radiological outcomes of percutaneous kyphoplasty (PKP) versus posterior fixation combined with vertebroplasty PF+VP for treating stage III Kümmell's disease (KD) patients without neurological deficits. METHODS: From April 2016 to February 2020, a total of 88 patients with single-level stage III KD without neurological deficits, including 45 patients treated by PKP and 43 patients who underwent posterior fixation combined with vertebroplasty PF+VP, were retrospectively studied. The outcome parameters, including blood loss, operative time, kyphotic Cobb angle, height of vertebrae, Oswestry Disability Index (ODI), and visual analog scale (VAS) score, were compared between the PKP group and the PF+VP group. RESULTS: The mean follow-up time was 29.3 ± 7.0 months, ranging from 24 to 48 months. The kyphotic angle and vertebral height in both groups were significantly improved compared with those before surgery at three days, 3 months and the final follow-up. The estimated blood loss, operative time, and length of stay were significantly lower in the PKP group than in the PF+VP group (P < 0.001). The FP+VP group showed better results in kyphotic angle correction than the PKP group (P = 0.024). In the short-term follow-up (up to 3 months), the PKP group had lower VAS and ODI scores than the PF+VP group. In contrast, there were no significant differences between the two groups (P > 0.05) at the final follow-up. The average cost of PKP was lower than that of PF+VP. CONCLUSION: The results of our study showed that both PKP and PF+VP were safe and effective for stage III KD patients without neurological deficits. Although PF+VP presents better performance in kyphotic angle correction, PKP was associated with less surgical trauma, quicker pain relief, and lower expense than PF+VP. Therefore, it can be considered an alternative option for patients with advanced KD.