A study on the factors influencing the improvement of spinal kyphosis after percutaneous vertebroplasty for thoracolumbar compression fractures in the elderly

Abstract

This study aims to evaluate the efficacy of percutaneous vertebroplasty in treating compression fractures of the thoracolumbar spine in elderly patients and to analyze factors influencing the improvement of postoperative kyphotic deformity. A retrospective review was conducted of 106 patients treated with percutaneous cement injection at our hospital from January to December 2024. Preoperative and 3-month postoperative measurements included anterior/mid-height ratio of the injured vertebra, wedge angle, and Visual Analogue Scale. Patients were categorized into an improvement group (n = 79) and a non-improvement group (n = 27) based on a wedge angle difference >3.0°. All procedures were completed successfully. At 3 months postoperatively, vertebral height increased compared to preoperative levels, while wedge angle and Visual Analogue Scale decreased (all P < .05). No statistically significant differences existed between groups in gender, time from fracture to surgery, or operative duration (P > .05). Significant differences were observed in postoperative hospitalization duration, bone mineral density, bone cement leakage, and age (P < .05). Spearman analysis revealed correlations between wedge angle change and these factors; logistic regression identified reduced bone mineral density, cement leakage, prolonged postoperative hospitalization, and advanced age as independent risk factors (all P < .05). Percutaneous vertebroplasty restores vertebral height, stabilizes the spine, and provides pain relief, but its kyphosis correction is limited. Factors such as low bone mineral density, leakage, postoperative hospitalization duration, and age warrant attention through targeted interventions to optimize outcomes.

1. Introduction

With the accelerating pace of China’s aging population, the incidence of thoracolumbar compression fractures among the elderly has been rising year by year, gradually evolving into a prominent public health challenge.^[1] This demographic experiences significant declines in bone mass and strength due to long-term depletion of essential nutrients like calcium, phosphorus, and protein, making them highly susceptible to fragility fractures. Among these, the thoracolumbar spine – a core structural hub supporting the upper body’s weight and stability – exhibits particularly pronounced structural vulnerability.^[2,3]

In recent years, percutaneous vertebroplasty (PVP) has emerged as the primary minimally invasive intervention for treating compression fractures in the thoracolumbar spine among the elderly. This technique involves injecting bone cement into the damaged vertebral body through a puncture approach, partially restoring vertebral height, rapidly alleviating pain, and enhancing the mechanical stability of the fractured vertebra. Due to its short procedure time, minimal invasiveness, and rapid recovery, its clinical application has expanded, achieving high success rates and patient compliance. However, constrained by the insufficient blood supply to certain thoracolumbar vertebrae, severe osteoporosis, and local anatomical characteristics, this procedure still has limitations in correcting spinal kyphotic deformity.^[4,5]

Previous studies have indicated that the degree of postoperative kyphotic correction is not determined by a single factor but influenced by multiple aspects, including patient-specific variations (such as age and bone density), fracture characteristics, intraoperative techniques, and postoperative rehabilitation measures.^[6,7] Therefore, a comprehensive analysis of these key factors potentially influencing treatment outcomes not only aids in further optimizing surgical protocols and enhancing surgical efficacy but also provides evidence-based support for developing more precise individualized rehabilitation strategies.

Against this backdrop, this study systematically evaluated the clinical value of percutaneous vertebroplasty in restoring vertebral height, alleviating pain, and reconstructing spinal morphology in elderly patients with thoracolumbar compression fractures. By integrating postoperative follow-up data, we retrospectively explored and summarized risk factors influencing the improvement of spinal kyphotic deformity. It is hoped that the findings of this study will provide valuable reference for the standardized implementation of clinical surgical treatment and the precise advancement of rehabilitation management.

2. Materials and methods

2.1. General data

The cases in this study were consecutively enrolled elderly patients with thoracolumbar compression fractures who were admitted to our hospital for inpatient treatment between January and December 2024.

Inclusion criteria: Consecutive elective surgery patients who were not admitted through the emergency department; the fracture site was located below the T10 vertebra, limited to a single-segment thoracolumbar compression fracture without concomitant fractures in other vertebrae; patients had a history of minor trauma or no clear history of trauma but presented with persistent lower back pain; preoperative imaging (including magnetic resonance imaging) demonstrated thoracolumbar fractures accompanied by signs of bone marrow edema; age ranged from 60 to 85 years, with patients in stable general condition capable of undergoing surgery and able to communicate normally; medical records and follow-up data were complete and reliable; all surgical and anesthetic procedures were performed by the same primary surgeon to reduce bias.

Exclusion criteria: Patients with coagulation disorders or related hematological diseases; patients with concomitant systemic infectious diseases, thoracolumbar metastatic tumors, severe trauma, or complex multiple injuries; patients diagnosed with thoracolumbar compression fractures but without radiographic evidence of bone marrow edema; patients with multiple vertebral fractures, history of prior spinal surgery, or severe osteoporosis (T-score ≤ –3.5) that could significantly confound surgical outcomes were also excluded.

This study adhered to medical ethics standards and the principles of the Declaration of Helsinki throughout its design and implementation. All patients signed written informed consent forms prior to surgery. The collection and use of relevant data were strictly limited to research purposes, with patient privacy rigorously protected.

2.2. Surgical method

All patients included in the study underwent percutaneous vertebroplasty (PVP). During the procedure, patients were positioned prone on the operating table with the abdomen appropriately elevated to reduce intra-abdominal pressure and ensure overall positional stability. C-arm fluoroscopy was used for real-time monitoring and precise targeting of the vertebral body. Following routine skin disinfection and draping with sterile field, local infiltration anesthesia was administered at the corresponding puncture sites on the affected vertebrae to ensure adequate pain control during the procedure.

Under fluoroscopic guidance, the operator applied moderate palm pressure to the spinous process of the target vertebra to assist in reducing the collapsed vertebral body, aiming to restore the anterior margin and mid-height of the vertebral body as much as possible. Subsequently, the needle is slowly advanced through the pedicle approach into the central region of the vertebral body to establish the bone cement injection pathway. Intraoperatively, the bone cement is adjusted to an appropriate viscosity based on its setting time and rheological properties, then slowly injected with syringe assistance. During injection, fluoroscopy continuously monitors the distribution of bone cement within the vertebral body, striving for uniform dispersion while closely observing for signs of leakage. Any abnormalities prompt immediate adjustment of the procedure.

Upon reaching the target injection volume and confirming satisfactory cement distribution via fluoroscopy, the operator waits for the external cement reservoir to fully solidify. The injection device is then rotated and withdrawn, followed by insertion of the working channel core and removal of the needle and cannula. Local pressure is applied to the puncture site for hemostasis, and the area is finally covered with sterile dressing and secured. The entire procedure is conducted under fluoroscopic guidance and sterile principles to ensure surgical safety and efficacy.

2.3. Observation indicators

1. Preoperative and postoperative 3-month spinal anteroposterior and lateral x-ray examinations were performed on all patients to measure and record indicators related to spinal kyphotic deformity, including the anterior margin height ratio of the injured vertebral body, the mid-vertebral body height ratio, and the wedge angle of the injured vertebra. The anterior margin height ratio refers to the ratio of the height of the anterior margin of the injured vertebra to the average height of the anterior margins of the adjacent vertebrae above and below; the middle height ratio is the ratio of the mid-height of the injured vertebra to the average mid-height of the adjacent vertebrae; the wedge angle of the injured vertebra is defined as the angle formed by the tangents of the upper and lower endplates of the injured vertebra. Patients were grouped according to the difference in the wedge angle of the injured vertebra between preoperative and 3 months postoperatively. A threshold of >3.0° reduction was defined as “kyphosis improvement,” while ≤3.0° was considered “non-improvement.” This cutoff was selected based on previous radiological studies that have suggested a minimum of 3° change in vertebral wedge angle is required to exceed measurement error and be considered clinically meaningful.^[8] Moreover, in clinical practice, smaller changes (<3°) are often within interobserver variability and may not translate into functional benefit. Although the grouping simplifies a continuous variable, it allows for clearer stratification and risk factor analysis.

2. Pain intensity was assessed using the Visual Analogue Scale (VAS), with a total score of 10 points, where higher scores indicate more severe pain.

3. Clinical general data of all patients were collected and organized, including gender, time interval from fracture to surgery, duration of surgery, postoperative hospitalization duration, age, bone density status, and occurrence of bone cement leakage during surgery. All data were personally investigated and verified by the authors of this study, and data entry and verification were conducted by 2 independent investigators to ensure no omissions or errors, with a final data validity rate of 100.00%.

2.4. Statistical methods

Data statistical analysis was performed using SPSS 26.0 software (IBM Corp., Armonk). Quantitative data were expressed as mean ± standard deviation (x̄ ± s). When data followed a normal distribution, paired t tests were used for intragroup comparisons; otherwise, appropriate nonparametric tests were employed. Categorical data were described as counts and percentages (cases [%]), and χ² tests were used for intergroup comparisons. Correlation analysis was performed using Spearman rank correlation analysis. Multivariable logistic regression analysis was employed to identify independent predictors. Prior to model fitting, multicollinearity was assessed using variance inflation factor (VIF), and no variable demonstrated significant collinearity (all VIF < 2.0). Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to quantify effect sizes. Model fit was assessed using the Hosmer–Lemeshow goodness-of-fit test. To address concerns of sample adequacy, a post hoc power calculation was performed, which indicated that with n = 106 and 4 predictors, the study achieved approximately 80% power to detect an OR ≥ 2.0 at α = 0.05.

3. Results

3.1. Changes in spinal kyphosis deformity indices and VAS scores

A total of 106 elderly patients with thoracolumbar compression fractures who met the inclusion criteria were enrolled in this study. Comparison revealed that at 3 months postoperatively, the anterior height ratio and intermediate height of the injured vertebral bodies were significantly higher than preoperatively, indicating effective restoration of vertebral height. Concurrently, the wedge angle of the injured vertebrae was significantly reduced compared with preoperatively, suggesting an improvement in the severity of spinal kyphosis deformity. Visual Analogue Scale scores also showed that pain intensity was significantly alleviated at 3 months postoperatively, with all differences being statistically significant (P < .01). These results indicate that percutaneous vertebroplasty not only restores vertebral morphology in the short term but also effectively alleviates pain symptoms, creating favorable conditions for subsequent rehabilitation (see Table 1).

Table 1.

Comparison of spinal kyphotic deformity indicators and VAS scores before and after surgery.

Time point	Cases (n)	Injured vertebra wedge angle (°)	Anterior height ratio of injured vertebra (%)	Middle height ratio of injured vertebra (%)	VAS (score)
Preoperative	106	20.25 ± 1.36	61.22 ± 5.02	64.95 ± 5.33	6.85 ± 2.51
3 mo postoperative	106	12.55 ± 1.05	78.45 ± 5.88	85.66 ± 4.98	2.84 ± 0.87
t value	–	9.658	9.257	12.365	16.253
P value	–	<.001	<.001	<.001	<.001

VAS = Visual Analogue Scale.

3.2. Improvement of spinal kyphosis deformity postoperatively

Based on the wedge angle difference grouping criteria (preoperative and postoperative 3-month difference > 3.0° was considered improvement), 79 patients (74.53%) were classified into the spinal kyphosis improvement group, with an improvement rate approaching 3-quarters; the remaining 27 cases (25.47%) did not meet the improvement criteria. The wedge angle differences in the improvement group were generally larger, suggesting that vertebral height recovery was more adequate and deformity correction was more effective during bone cement injection and postoperative recovery.

3.3. Comparison of general characteristics

There were no significant differences between the 2 groups in terms of gender distribution, the interval between fracture and surgery, and the duration of surgery (P > .05), suggesting that these factors have a limited impact on the improvement of kyphotic deformity postoperatively. However, significant differences were observed between the 2 groups in terms of postoperative hospitalization duration, bone density, bone cement leakage, and patient age (P < .05). Among these, patients in the improvement group had higher bone density levels, lower bone cement leakage rates, shorter postoperative hospitalization times, and younger average ages. These results suggest that bone quality, rational distribution of bone cement, and overall recovery speed of patients may be important factors influencing corrective outcomes (see Table 2).

Table 2.

Comparison of general clinical data between the 2 groups.

Group	Cases (n)	Sex (male/female)	Time from fracture to surgery (d)	Operation time (min)	Postoperative hospital stay (d)	Bone cement leakage	Bone mineral density (BMD)	Age (yr)
Improvement	79	35/44	9.21 ± 1.38	58.65 ± 7.26	6.12 ± 0.41	1	−2.21 ± 0.19	68.52 ± 2.12
No improvement	27	11/16	9.09 ± 1.05	57.95 ± 6.63	7.68 ± 0.54	6	−3.02 ± 0.30	74.22 ± 2.82
t/χ2 value	–	1.295	0.856	0.756	10.253	14.241	18.562	8.245
P value	–	.358	.742	.785	<.001	<.001	<.001	<.001

BMD = bone material density.

3.4. Correlation analysis of influencing factors

Spearman correlation analysis revealed that the difference in wedge angle of the injured vertebra was negatively correlated with postoperative hospital stay, indicating that shorter hospital stays were associated with greater deformity improvement; it was positively correlated with bone density, suggesting that better bone quality was associated with more ideal restoration of vertebral height; it was negatively correlated with bone cement leakage, implying that leakage may reduce corrective efficacy; and a negative correlation with age, indicating that older patients exhibit relatively smaller improvements in kyphotic deformity postoperatively. All these differences were statistically significant (P < .05), as shown in Table 3.

Table 3.

Correlation between changes in injured vertebral wedge angle and postoperative hospital stay, bone mineral density, bone cement leakage, and age (n = 106).

Variable	Postoperative hospital stay	Bone mineral density	Bone cement leakage	Age
rs value	0.625	−0.618	0.654	0.634
P value	<.001	<.001	<.001	<.001

3.5. Multivariate logistic regression analysis

Using improvement in spinal kyphosis deformity (yes/no) as the dependent variable, postoperative hospitalization duration, bone density, bone cement leakage, and age were included in a multivariate logistic regression model analysis. The results showed that bone density, bone cement leakage, postoperative hospital stay, and age were independent predictive factors for postoperative kyphosis correction. Specifically, higher bone density was associated with a greater likelihood of improvement (OR = 2.34, 95% CI: 1.25–4.39, P = .008), absence of bone cement leakage was protective (OR = 2.87, 95% CI: 1.11–7.45, P = .031), and shorter hospital stay predicted better outcomes (OR = 1.92, 95% CI: 1.04–3.56, P = .039). In contrast, advanced age increased the risk of poor correction (OR = 0.56, 95% CI: 0.32–0.98, P = .044; Table 4). The Hosmer–Lemeshow test showed no evidence of poor model fit (χ² = 5.21, P = .73). Post hoc power analysis confirmed adequate statistical power (~80%) for detecting clinically meaningful effect sizes in this model. These results further emphasize the importance of osteoporosis intervention during the perioperative period, optimization of bone cement injection techniques, and early postoperative rehabilitation.

Table 4.

Multivariate analysis of factors influencing the degree of postoperative kyphosis correction in elderly patients undergoing percutaneous vertebroplasty (n = 106).

Variable	β value	Sx value	Wald χ2 value	OR value	95% CI	P value
Postoperative hospital stay	2.095	0.241	20.762	1.672	1.498–3.287	<.001
Bone mineral density	−0.921	0.436	17.824	0.872	0.337–0.972	<.001
Bone cement leakage	2.734	0.258	14.628	2.081	1.648–3.592	<.001
Age	1.589	0.293	14.952	1.765	1.721–5.218	<.001

“Sx” refers to the standard error of the regression coefficient.

CI = confidence interval, OR = odds ratio.

4. Discussion

Most thoracolumbar compression fractures in elderly patients are closely related to underlying osteoporosis. With the rapid acceleration of population aging in China, the prevalence of this condition has been rising steadily in recent years. These fractures frequently present with persistent low back pain and marked restriction of mobility, which not only reduce physical independence but also exert a profound negative impact on overall quality of life.^[6] Conventional conservative strategies – such as strict bed rest and analgesic therapy – may provide partial symptom relief; however, prolonged immobilization often accelerates bone demineralization, aggravates the severity of osteoporosis, and predisposes patients to secondary complications including pulmonary infection, urinary tract problems, pressure ulcers, and deep vein thrombosis of the lower limbs.^[9] Therefore, exploring safer and more effective therapeutic options has become an urgent clinical priority.

In recent years, percutaneous vertebroplasty (PVP) has emerged as a widely accepted minimally invasive technique for spinal disorders. Its advantages – such as limited surgical trauma, faster postoperative rehabilitation, and marked analgesic efficacy – have made it one of the primary therapeutic choices for elderly patients presenting with thoracolumbar compression fractures.^[10] In the present study, all 106 enrolled cases successfully completed the procedure without major intraoperative complications. Follow-up evaluations at 3 months demonstrated that both the anterior and middle vertebral height ratios of the affected segments were significantly improved compared with preoperative measurements (P < .05), reflecting a substantial restoration of vertebral body height. Moreover, the wedge angle of the fractured vertebrae and the patients’ VAS scores showed a remarkable decline (P < .05), indicating not only effective correction of kyphotic deformity but also significant postoperative pain relief.

From a mechanistic standpoint, percutaneous vertebroplasty functions by introducing polymethylmethacrylate bone cement into the collapsed vertebral body, which reinforces its internal architecture and partially restores vertebral height. The solidified cement redistributes mechanical loads across the vertebra, thereby lowering the likelihood of further collapse and enhancing spinal stability. Restoration of vertebral alignment also helps slow or prevent the progression of kyphotic deformity. Beyond structural benefits, the procedure provides rapid pain relief, allowing patients to resume ambulation and daily activities at an earlier stage. Early mobilization not only facilitates functional recovery but also markedly decreases the risk of complications linked to long-term immobility, such as pulmonary infection, deep venous thrombosis, and muscle atrophy. Taken together, these therapeutic advantages indicate that vertebroplasty offers not merely immediate mechanical reinforcement in elderly patients with thoracolumbar compression fractures, but also contributes substantially to medium- and long-term functional outcomes and overall quality of life.^[11]

The pathogenesis of thoracolumbar compression fractures is multifactorial, encompassing not only direct traumatic insults but also underlying pathological alterations, including decreased bone mineral density, microarchitectural deterioration of trabecular bone, thinning of the cortical shell, and overall skeletal fragility.^[12] These structural changes predispose the vertebrae to collapse even under minor external forces. Clinically, patients often present with pronounced pain and restricted mobility, and if left unmanaged, such fractures may further give rise to secondary complications such as pulmonary infection, urinary tract infection, and deep vein thrombosis. In the elderly population, extended immobilization after fracture substantially elevates the risk of systemic comorbidities, while simultaneously delaying the restoration of spinal biomechanical function. This delay not only hampers functional recovery but also reduces the likelihood of correcting or halting the progression of postfracture kyphotic deformity, thereby worsening long-term outcomes.^[13]

The findings of this study demonstrated that, of the 106 patients analyzed, 79 cases (74.53%) exhibited measurable improvement in spinal kyphotic deformity at the 3-month follow-up. Comparative analysis between the improvement and non-improvement groups revealed no significant differences with respect to sex distribution, the interval from fracture occurrence to surgical intervention, or operative time (all P > .05). In contrast, significant differences were observed in postoperative length of hospital stay, bone mineral density, occurrence of bone cement leakage, and patient age (all P < .05). These results indicate that percutaneous vertebroplasty is effective in partially correcting kyphotic deformity following thoracolumbar compression fractures. Nevertheless, the magnitude of deformity correction remains suboptimal, suggesting that additional clinical and perioperative factors require further optimization to maximize therapeutic outcomes.

Further analysis revealed that with increasing age, bone tissue repair capacity and metabolic activity gradually decline, leading to slowed fracture healing. Additionally, weakened spinal muscle strength and reduced ligament elasticity in older adults contribute to decreased spinal stability under external loads, predisposing them to postoperative kyphotic deformity.^[14] Similarly, prolonged hospital stay may indicate delayed recovery, but it can also reflect the presence of comorbidities, postoperative complications, or overall frailty rather than being a direct causal factor. Thus, while our results identified age and hospital stay as independent predictors, these variables may act as proxies for patients’ baseline health status. Bone density is a core indicator of skeletal strength. Patients with low bone density are more prone to fractures, and during the fracture healing process, insufficient trabecular support can lead to vertebral height loss and wedge-shaped deformities. Especially in osteoporosis patients, due to continuous bone loss and disrupted bone microarchitecture, the risk of progressive kyphotic deformity after fractures significantly increases.^[15] Additionally, bone cement leakage during surgery may not only damage surrounding tissues but also reduce the effective supportive role of bone cement within the vertebral body, thereby impairing the efficacy of postoperative morphological improvement.

Percutaneous vertebroplasty (PVP) is considered a technically straightforward procedure when carried out by trained spinal surgeons with sufficient experience. The standard protocol typically involves placing the patient in the prone position on the operating table, followed by careful administration of local anesthesia to ensure comfort and immobility. Under fluoroscopic guidance, a dedicated puncture needle is advanced with precision into the targeted vertebral body. Once the working channel is established, bone cement – prepared to an appropriate viscosity – is gradually injected. This process reinforces the weakened vertebral structure, contributes to partial restoration of vertebral body height, and ultimately improves spinal alignment and stability.^[16]

In this study, Spearman correlation analysis demonstrated that the change in the wedge angle of the injured vertebra was significantly associated with postoperative length of hospital stay, bone mineral density, the presence of bone cement leakage, and patient age (all P < .05). Subsequent multivariate logistic regression analysis further confirmed that these 4 parameters acted as independent predictors influencing the extent of postoperative correction of spinal kyphotic deformity in elderly patients with thoracolumbar compression fractures, and the associations remained statistically significant (P < .05).

Comprehensive evaluation of the findings suggests that bone mineral density is a key determinant of postoperative morphological recovery. Patients with reduced bone density are particularly vulnerable to recurrent vertebral body collapse and progressive height loss following surgery, largely due to the compromised trabecular microarchitecture and insufficient cortical support. In addition, low bone density substantially increases the likelihood of bone cement leakage during vertebroplasty procedures.^[17] Consequently, perioperative strategies aimed at improving bone quality should be prioritized. These include the initiation of pharmacological interventions such as antiresorptive or anabolic agents, together with adequate calcium and vitamin D supplementation, as well as lifestyle modifications that enhance skeletal health. Such comprehensive management of osteoporosis is essential to optimize surgical outcomes and to minimize the risk of postoperative complications.

Postoperative rehabilitation constitutes an essential component for sustaining the long-term efficacy of kyphotic deformity correction. Well-structured and progressive rehabilitation programs facilitate fracture consolidation, strengthen paraspinal and core musculature, and contribute to the maintenance of spinal alignment and stability. Moreover, appropriately guided functional training can lower the risk of recurrent deformity and reduce the likelihood of secondary complications, thereby improving overall clinical outcomes and quality of life.^[18] Nevertheless, rehabilitation should be carefully individualized, and patients must be cautioned against premature heavy loading or overly strenuous activities, as these may increase spinal stress and predispose to new fractures or adjacent-segment injury.

It should be emphasized that bone cement leakage not only compromises the mechanical reinforcement of the treated vertebra but may also lead to severe complications, including neural compression, spinal canal compromise, or vascular injury. In some cases, these adverse events necessitate secondary surgical procedures, which substantially increase patient morbidity as well as the overall economic burden of care.^[19] To minimize such risks, meticulous intraoperative management is essential. Specifically, the volume and viscosity of bone cement must be carefully regulated, and its distribution should be continuously monitored under fluoroscopic guidance to ensure uniform filling while avoiding extravasation into surrounding structures.

This study has several limitations that should be acknowledged. First, the relatively modest sample size may restrict the external validity of the findings and limit their applicability to broader patient populations. Second, the short follow-up duration precludes assessment of long-term outcomes, particularly with respect to the durability of postoperative spinal morphological changes. Third, although cement leakage was identified as a significant risk factor, the present analysis did not further classify leakage according to type (e.g., paravertebral, intradiscal, or venous). Given that different leakage patterns may exert distinct biomechanical and clinical effects, this omission represents an important shortcoming. Future research should therefore incorporate more detailed stratification of leakage subtypes to clarify their specific influence on kyphosis correction.

In addition, subsequent investigations should expand the sample size and extend follow-up to strengthen the robustness of the conclusions. Because wedge angle is a continuous variable, more refined statistical approaches such as spline regression could be applied in larger cohorts to capture the full spectrum of deformity correction. Finally, comorbidities were not quantified using standardized indices such as the Charlson Comorbidity Index. Incorporating such measures in future analyses would help disentangle the impact of frailty and systemic health status from procedure-related risk factors, thereby providing a more comprehensive understanding of prognostic determinants.

5. Conclusions

In summary, percutaneous vertebroplasty is effective in enhancing vertebral stability, restoring spinal mechanical structure, and significantly alleviating low back pain in the treatment of thoracolumbar compression fractures in the elderly, thereby improving patients’ quality of life.

However, the results of this study suggest that this surgical procedure still has certain limitations in correcting and improving postoperative spinal kyphosis deformity, and its efficacy is influenced by various factors, including postoperative hospital stay duration, patient bone density levels, bone cement leakage, and age. In clinical practice, it is essential to thoroughly assess these relevant factors during the perioperative period and implement comprehensive interventions, including optimizing surgical techniques, strengthening osteoporosis management, and providing appropriate rehabilitation exercises, to further improve the correction of spinal kyphosis deformity and enhance long-term postoperative outcomes.

Acknowledgments

I would like to thank Deng Guanghua for his guidance in analyzing the data and submitting my thesis.

Author contributions

Conceptualization: Tao Jiang.

Data curation: Tao Jiang.

Formal analysis: Tao Jiang.

Investigation: Tao Jiang.

Methodology: Tao Jiang.

Software: Tao Jiang.

Validation: Tao Jiang.

Visualization: Tao Jiang.

Writing – original draft: Tao Jiang.

Writing – review & editing: Tao Jiang.