The Impact of Bone Cement Distribution in Unilateral PVP on Therapeutic Outcomes of Vertebral Compression Fracture Repair

Background: Osteoporotic vertebral compression fractures (OVCFs) are common in the elderly, severely impacting health and quality of life. Percutaneous vertebroplasty (PVP) is a primary treatment, with bone cement distribution being a key factor influencing its efficacy. Objective: This study aimed to evaluate the impact of bone cement distribution patterns on clinical outcomes in unilateral PVP for OVCFs. Methods: A total of 145 patients undergoing first-time unilateral PVP were retrospectively analyzed. Based on postoperative anteroposterior X-rays, patients were divided into three groups according to cement coverage: Group A (uniform distribution across three vertebral regions, n=57), Group B (covering > 1/2 to ≤ 2/3, n=51), and Group C (covering > 1/3 to ≤ 1/2, n=37). Primary outcomes (VAS, ODI, vertebral height recovery, refracture rate) and secondary outcomes were compared. Results: At one-year follow-up, VAS scores were significantly lower in Groups A (2.12± 0.54) and B (2.16± 0.54) than in Group C (2.43± 0.50, P< 0.05). Vertebral height recovery was superior in Groups A and B compared to Group C (P< 0.05). The overall refracture rate was significantly lower in Group A (3.6%) than in Group C (18.9%, P< 0.05), with no significant difference from Group B (3.9%). Group A received a higher cement volume (4.95± 0.43 mL) than Groups B and C (P< 0.05). Conclusion: Bone cement distribution crossing the vertebral midline is associated with better pain relief, improved vertebral height restoration, and a lower refracture rate after unilateral PVP. However, exceeding two-thirds vertebral coverage does not appear to be a critical factor for surgical efficacy.