Assessing the Role of Expandable Vertebral Augmentation versus High-Viscosity Cement Vertebroplasty in Severe Osteoporotic Vertebral Fracture Management: A Prospective Cohort Study

Abstract

Objective: This study aims to compare the efficacy of expandable vertebral augmentation (EVA) versus high-viscosity cement vertebroplasty (HVCV) in patients with severe osteoporotic vertebral compression fractures to determine which intervention offers greater benefits. Methods: This prospective cohort study enrolled symptomatic osteoporotic compression fracture patients from a single center in Taiwan between 2018 and 2020, all of whom presented a loss of body height exceeding 40%. Patients were allocated to either the EVA or HVCV group. The primary outcome measure was radiographic assessment, including vertebral body height restoration and kyphotic angle correction at 12 months postoperatively. The secondary outcomes included the incidence of adjacent fractures and cement leakage. Results: In this prospective cohort study, a total of 98 patients were allocated to the EVA (46 cases) or HVCV (52 cases) group; the cohort had a mean age of 77.1 years, with women accounting for 77% of participants. Radiographic outcomes demonstrated that the EVA group experienced a significantly greater improvement in vertebral body height and kyphotic angle (mean improvement, 64.0%) than the HVCV group (mean improvement, 40.4%). The incidence of postoperative complications such as adjacent fractures and cement leakage did not differ significantly between the groups (P > 0.05), indicating comparable safety profiles. Conclusions: Our findings indicate that the EVA group is superior to the HVCV group for vertebral height restoration and kyphotic angle correction; both techniques showing effective management and safety profiles.