Impact of Intravertebral Cleft Types on Percutaneous Kyphoplasty Outcomes in Osteoporotic Vertebral Compression Fractures

To investigate the therapeutic effect and radiographic results of percutaneous kyphoplasty (PKP) in patients with osteoporotic vertebral compression fractures (OVCFs) with or without intravertebral clefts (IVCs). The clinical data of 288 patients with OVCFs who underwent PKP surgery were retrospectively analyzed and stratified into liquid-IVC group, gas-IVC group, and non-IVC group through magnetic resonance imaging. Baseline characteristics revealed that the liquid-IVC group had an older age profile and a higher proportion of male participants (P < 0.05). All patients exhibited pain relief, vertebral height (VH) improvement, and kyphotic angle correction immediately after PKP surgery (P < 0.05). The score of bone cement distribution was significantly lower (P < 0.05) in the liquid-IVC group but the VH improvement rate (VHIR), VH change rate (VHCR) and the re-collapse rate were significantly higher (P < 0.05) than the other two groups. Moreover, the non-IVC group demonstrated a significantly lower incidence of post-operative bone cement leakage compared to the other two groups (P < 0.05). However, the VH and Cobb angle significantly decreased in all groups during the follow-up period (P < 0.05). Further analysis revealed significant correlation between bone cement distribution and IVC (by evaluating the injury zone score) in the liquid-IVC groups (R ²  = 0.371, P < 0.05), whereas no significant difference was found in the other two groups (R ² = -0.123, P = 0.218). In conclusion, PKP is effective in treating OVCFs with or without IVCs, but liquid-filled IVCs exhibit a worse therapeutic effect in radiographic parameters than gas-filled and non-IVCs during follow-up. Patients with liquid-filled IVCs also have limited and IVC-related bone cement distribution.