Clinical Outcomes of Percutaneous Vertebroplasty and Conservative Management in Patients With Osteoporotic Vertebral Compression Fractures

Abstract

Background

The optimal treatment strategy for osteoporotic vertebral compression fractures (OVCFs) remains unclear. This single-center study aimed to compare outcomes of percutaneous vertebroplasty (PVP) and conservative management in 55 patients with OVCF.

Material/Methods

Between January 2021 and January 2023, 55 patients with OVCF were enrolled. Thirteen patients underwent PVP (PVP group), and 42 patients received conservative treatment (conservative group). The visual analog scale (VAS), Oswestry Disability Index (ODI), kyphosis angle, complications, and duration of bed rest were evaluated.

Results

VAS and ODI scores in the PVP group significantly decreased at 1 week after surgery, whereas significant improvements in the conservative group were observed at 1 month (P < 0.05). VAS and ODI scores were significantly better in the PVP group than in the conservative group during the first 3 months (P < 0.05), but no significant differences were observed after 6 months (P > 0.05). Kyphosis angle significantly improved in both groups after treatment (P < 0.05); no significant between-group difference was observed (P > 0.05). Duration of bed rest was significantly longer in the conservative group (P < 0.05). No significant difference in complications was observed between groups (P > 0.05).

Conclusions

Both PVP and conservative treatment relieved pain and improved quality of life in patients with OVCF. PVP provided more rapid pain relief and functional recovery. Although conservative treatment resulted in slower improvement and longer duration of bed rest, long-term clinical outcomes and complication rates were similar between groups.

Introduction

Because of population aging, the incidences of osteoporosis and osteoporotic fractures have substantially increased. Osteoporotic fractures have become a global public health concern, among which osteoporotic vertebral compression fractures (OVCFs) are most common, representing nearly 50% of all osteoporotic fractures [1]. Typically caused by biomechanical failure under axial or compressive loading, these fractures predominantly involve the anterior column of the vertebral body and usually result in a characteristic wedge-shaped deformity. Approximately 1.416 million cases of OVCF occur worldwide each year, and around 40% of women experience at least 1 OVCF during their lifetime [2]. Clinical manifestations include severe lower back pain, limited mobility, kyphotic deformity, and even neurological injury [3,4], substantially impairing patients’ quality of life.

Although conservative treatment, including analgesics, orthotic bracing, and rehabilitation, remains the primary therapeutic modality, surgical intervention is indicated for unstable fractures, fractures complicated by neurological dysfunction, or fractures with severe deformity. Conservative treatment has a favorable long-term prognosis and low cost, but it is associated with slower pain relief, prolonged bed rest, and a higher risk of complications [5]. Such treatment is often unacceptable for patients with poor compliance or those who wish to resume work and daily activities as soon as possible, leading many to seek minimally invasive surgical treatment. Currently, percutaneous vertebroplasty (PVP) is among the most widely used minimally invasive surgical options for OVCF and has been extensively adopted in clinical practice [6]. PVP offers several advantages, including minimal surgical trauma, effective pain relief, and rapid recovery; however, it is associated with a risk of bone cement leakage and higher treatment costs.

Both conservative treatment and minimally invasive PVP have distinct advantages and disadvantages. At present, there remains considerable controversy regarding the choice between PVP and conservative treatment for OVCF. Additionally, the thoracolumbar osteoporotic fracture score assessment system (TLOFSAS) was introduced to establish inclusion criteria, facilitating clinical application of this quantitative scoring system for the diagnosis and treatment of OVCF. This single-center study aimed to compare the outcomes of PVP and conservative management in 55 patients with OVCFs.

Material and Methods

Ethics Statement

The study was approved by the Ethics Committee of Honghui Hospital, Xi’an Jiaotong University (approval number: 202405004). Written informed consent was obtained from all participants. This study was conducted in accordance with the principles of the Declaration of Helsinki.

Inclusion and Exclusion Criteria

Inclusion criteria were as follows: (1) consistent with Denis’s 3-column theory, fractures involving only the anterior column of the spine (including biconcave collapse of the upper and lower endplates); (2) fracture site between T11 and L3; (3) total TLOFSAS score of 3 points (no obvious signs of fracture on radiographic examination, 0 points; clinically significant T1- and T2-weighted signal changes on magnetic resonance imaging, 1 point; bone mineral density −3.5 < T < −2.5, 1 point; lower back pain induced by changes in body position, 1 point); (4) intact posterior ligament complex; (5) disease duration up to 8 weeks; (6) single vertebral fracture; and (7) age greater than 50 years.

Exclusion criteria were as follows: (1) fractures involving other anatomical sites; (2) neurological injury; (3) previous vertebral fractures or spinal surgery; (4) pathological vertebral fractures caused by other diseases or back pain that could not be ruled out due to onset from other diseases; (5) stroke, dementia, malignant tumors, severe cardiopulmonary disease, or long-term corticosteroid use; (6) systemic or local puncture-site infection; (7) uncorrectable coagulation disorders; and (8) incomplete clinical information or missing data.

Study Population

A retrospective cohort study was conducted in 55 patients with symptomatic thoracolumbar OVCF who met the above criteria and were treated at Honghui Hospital, Xi’an Jiaotong University, between January 2021 and January 2023. The study population included 17 men and 38 women. Of these, 13 patients voluntarily underwent PVP because of mobility limitations caused by severe pain (PVP group); the remaining 42 patients received conservative treatment (conservative group). Injuries resulted from careless falls while walking (n = 30), sprains sustained during housework (n = 18), no identifiable cause (n = 4), and bumps sustained while riding in a vehicle (n = 3).

Treatment Methods

Conservative Group

All patients were prescribed bed rest for approximately 1 month, during which a cushion was placed beneath the lumbar spine to help restore the height of the fractured vertebra. After 1 month, patients gradually resumed ambulation while wearing a protective brace to minimize further loss of vertebral height. During this period, strenuous activities and weight-bearing exercise were avoided; analgesics were prescribed as needed. Anti-osteoporosis therapy consisted of a combination of 4 oral medications: calcium carbonate D3 tablets (Wyeth Pharmaceuticals Ltd; Chinese drug approval number H10950029; 600 mg), vitamin D2 softgel capsules (Nanjing Sea Whale Pharmaceutical Co, Ltd; Chinese drug approval number H32023837; 5000 IU), alfacalcidol (Chongqing Yaoyou Pharmaceutical Co, Ltd; Chinese drug approval number H10950134; 0.5 μg), and alendronate sodium tablets (Savio Industrial SrL; import drug registration number H20160100; 70 mg).

PVP Group

Patients were placed in the prone position, and the procedure was performed under local anesthesia. Cushions were placed beneath the chest, hips, and ankles to suspend the abdomen. The surgeon applied gentle manual pressure to the lower lumbar spine according to the patient’s tolerance for 5 to 10 minutes. Under C-arm fluoroscopic guidance, the fractured vertebra was visualized in the anteroposterior view to ensure that the spinous process was centered; the pedicle projection on the severely compressed side of the injured vertebra was identified and marked. The entry point was located approximately 1 cm lateral to the outer edge of the pedicle. After routine disinfection and sterile draping, local anesthesia was administered using 0.5% lidocaine, and an incision approximately 0.5 cm in length was made at the entry site. The puncture needle was advanced to the superolateral edge of the pedicle and gradually rotated under fluoroscopic guidance until its tip reached the medial edge of the pedicle on the anteroposterior view and the posterior edge of the vertebral body on the lateral view. The stylet was removed, and a vertebral drill was inserted. Under fluoroscopic guidance, the drill was advanced until it reached the center of the spinous process on the anteroposterior view and the anterior quarter of the vertebral body on the lateral view. The drill was then removed, and bone cement was rapidly injected into the vertebral body using a cement delivery device under continuous fluoroscopic monitoring. When the cement approached the posterior quarter of the vertebral body and adequate distribution was confirmed, the cement delivery device was withdrawn. The puncture needle was removed after approximately 1 minute, the puncture site was disinfected, and a sterile dressing was applied.

Post-Treatment Management

Both groups received a standardized 4-drug anti-osteoporosis regimen consisting of calcium carbonate D3 (600 mg once daily), vitamin D2 softgel capsules (5000 IU every 3 days after dinner), alfacalcidol (0.5 μg once daily, 30 minutes after meals), and alendronate sodium tablets (70 mg once weekly, taken 30 minutes before breakfast). To ensure adherence, patients were given a medication calendar at discharge specifying the timing and dosage of each medication. Additionally, monthly telephone follow-up was conducted to confirm medication adherence and record any missed doses. Anti-osteoporosis therapy was initiated immediately after injury; bone turnover markers and bone mineral density were assessed every 6 months to evaluate refracture risk. Discontinuation of therapy was considered when bone mineral density reached an acceptable level and the risk of refracture was low.

Both groups wore a standardized thoracolumbar brace provided by the hospital during ambulation for 2 months, with a minimum daily wear time of 8 hours. Adherence was monitored by assessing brace wear during follow-up visits and reviewing patient logs. Written instructions regarding brace use were provided to all patients at discharge. Both groups also followed a standardized rehabilitation program consisting of isometric lower back muscle exercises beginning 1 week after treatment and progressive core muscle strengthening beginning at 3 weeks. The rehabilitation program was designed by the same physical therapist, and adherence was assessed during follow-up visits. Only acetaminophen (≤ 3 g/day) or nonsteroidal anti-inflammatory drugs (eg, celecoxib 200 mg twice daily) were permitted for pain management; opioid use was prohibited. Analgesic types and dosages were recorded in the electronic medical record system.

Evaluation Indexes

All outcome measures were independently evaluated by 2 trained orthopedic physicians. Back pain was assessed using the visual analog scale (VAS), which consists of a 10-cm line anchored by “0” (no pain) and “10” (worst pain imaginable). Functional disability was assessed using the Oswestry Disability Index (ODI), which comprises 10 domains: pain intensity, personal care, lifting, walking, sitting, standing, sleeping, sexual activity, social life, and traveling. Each domain is scored from 0 to 5, and higher scores indicate greater disability. The total ODI score was calculated as (total score/50) × 100%. VAS and ODI scores were assessed before treatment and at 1 week and 1, 3, 6, and 12 months after treatment. The duration of bed rest and all complications were recorded. Complications evaluated in this study encompassed pulmonary infection, pressure ulcers, refracture of the treated vertebra, new vertebral fractures, and bone cement leakage. The kyphosis angle was defined as the angle between the superior endplate of the vertebra above the fracture and the inferior endplate of the vertebra below the fracture. The difference between post-treatment and pretreatment kyphosis angles was calculated to evaluate correction of the kyphotic deformity.

Statistical Analysis

Statistical analyses were performed using SPSS version 23.0 (IBM Corp., Armonk, NY, USA) and R software. Continuous variables were assessed for normality using the Shapiro-Wilk test. Normally distributed data were analyzed using independent-samples t-tests, whereas non-normally distributed data were analyzed using the Mann-Whitney U test. Cohen’s d and 95% confidence intervals (CIs) were reported as measures of effect size. Categorical variables were analyzed using the χ² test or Fisher’s exact test; odds ratios (ORs) and 95% CIs were reported. Repeated-measures analysis of variance was used to evaluate longitudinal changes in VAS and ODI scores. All tests were 2-sided, and P-values < 0.05 were considered statistically significant. Continuous variables are presented as means ± standard deviations; categorical variables are presented as counts and percentages.

Results

Patient Characteristics

All 13 patients in the PVP group underwent successful PVP. Patients in both groups were followed for more than 1 year after treatment; no deaths or other causes of study discontinuation occurred. Baseline characteristics—including sex, age, body mass index, medical history, bone mineral density, comorbidities, and fracture site—are presented in Table 1. No statistically significant differences between groups were observed regarding baseline characteristics (all P > 0.05; Table 1).

Table 1.

Comparison of baseline characteristics between groups.

	Conservative group	PVP group	OR/Cohen’s d	95% CI
Men/women	13/29	4/9	OR = 1.01	0.26–3.88
Age (years)	66.50 ± 6.78*	66.38 ± 6.97	Cohen’s d = 0.02	−0.61 to 0.64
BMI (kg/m2)	22.99 ± 2.31*	22.82 ± 2.18	Cohen’s d = 0.08	−0.55 to 0.70
Medical history (days)	19.93 ± 9.95*	18.31 ± 10.52	Cohen’s d = 0.16	−0.46 to 0.78
BMD (T score)	−3.03 ± 0.30*	−3.09 ± 0.29*	Cohen’s d = −0.21	−0.84 to 0.41
Comorbidities (yes/no)	18/24*	6/7	OR = 0.88	0.25–3.05
Fracture site
T11	8*	3	OR = 0.78	0.18–3.52
T12	15*	5	OR = 0.89	0.25–3.21
L1	11*	4	OR = 0.80	0.20–3.12
L2	6*	1	OR = 2.00	0.22–18.33
L3	2*	0	OR = 0.95	0.89–1.02

^*P > 0.05 vs PVP group.

Abbreviations: BMD, bone mineral density; BMI, body mass index; CI, confidence interval; OR, odds ratio; PVP, percutaneous vertebroplasty.

Clinical Outcomes

VAS and ODI scores in the PVP group were significantly lower at 1 week after treatment than at baseline (P < 0.05). In the conservative group, significant reductions in VAS and ODI scores were first observed at 1 month (P < 0.05). VAS and ODI scores were significantly better in the PVP group than in the conservative group during the first 3 months after treatment (P < 0.05); however, no significant differences were observed after 6 months (P > 0.05). Both groups had very low VAS and ODI scores after 6 months (Table 2). Both treatments relieved pain and improved function, although the PVP group achieved more rapid pain relief than the conservative group. The kyphosis angle was significantly reduced at 12 months compared with baseline in both groups (P < 0.05); no significant differences between groups were evident before or after treatment (P > 0.05) (Table 3). A representative case is shown in Figure 1.

Table 2.

VAS and ODI scores before and after treatment.

	VAS		Cohen’s d	95% CI	ODI		Cohen’s d	95% CI
	Conservative group	PVP group			Conservative group	PVP group
Pretreatment	7.80 ± 0.75	8.20 ± 0.89##	−0.51	−1.14 to 0.12	69.90 ± 3.33	70.15 ± 3.00##	−0.08	−0.7 to 0.55
1 w post-treatment	7.66 ± 0.78*	2.70 ± 0.95#,**	6.06	4.75–7.36	68.69 ± 5.81*	53.85 ± 3.96#,**	2.73	1.91–3.53
1 m post-treatment	5.98 ± 0.96#	2.50 ± 0.91#,**	3.66	2.72–4.59	59.98 ± 3.87#	47.69 ± 3.90#,**	3.17	2.3–4.03
3 m post-treatment	3.78 ± 1.02#	2.25 ± 1.01#,**	1.51	0.82–2.19	48.38 ± 4.74#	37.23 ± 4.80#,**	2.35	1.57–3.1
6 m post-treatment	2.22 ± 1.03#	2.12 ± 1.00#,##	0.11	−0.52 to 0.73	36.71 ± 4.23#	34.31 ± 4.75#,##	0.55	−0.08 to 1.18
12 m post-treatment	1.88 ± 1.10#	1.75 ± 1.16#,##	0.12	−0.51 to 0.74	31.00 ± 4.77#	30.92 ± 4.66#,##	0.02	−0.61 to 0.64

^*P > 0.05 vs pretreatment in same group;

^#P < 0.05 vs pretreatment in same group;

^**P < 0.05 vs conservative group at same time point;

^##P > 0.05 vs conservative group at same time point.

Abbreviations: CI, confidence interval; m, month(s); ODI, Oswestry Disability Index; PVP, percutaneous vertebroplasty; VAS, visual analog scale; w, week.

Table 3.

Duration of bed rest, kyphosis angle, and complications.

	Conservative group	PVP group	OR/Cohen’s d	95% CI
Duration of bed rest (days)	32.79 ± 4.57*	2.69 ± 1.25	Cohen’s d = 7.41	5.87–8.94
Complications (yes/no)	6/36**	4/9	OR = 0.375	0.09–1.62
Pretreatment KA (degrees)	12.3 ± 1.7**	12.4 ± 1.5	Cohen’s d = −0.06	−0.68 to 0.56
KA at 12 m post-treatment (degrees)	8.3 ± 1.1**	8.1 ± 1.2	Cohen’s d = 0.18	−0.45 to 0.80

^*P < 0.05 vs PVP group;

^**P > 0.05 vs PVP group.

Abbreviations: CI, confidence interval; KA, kyphosis angle; m, months; OR, odds ratio; PVP, percutaneous vertebroplasty.

Figure 1.

Radiological images obtained before and after percutaneous vertebroplasty in a patient with an osteoporotic vertebral compression fracture. (A) Lateral radiograph showing mild compression fracture of the T11 vertebral body. (B) Sagittal fat-suppressed magnetic resonance imaging demonstrating pronounced hyperintensity of the fractured T11 vertebral body. (C) Post-treatment lateral radiograph showing satisfactory distribution of bone cement within the T11 vertebral body. (Photograph taken with an iPhone 13, Apple).

Complications

Mean durations of bed rest were 32.79 ± 4.57 days in the conservative group and 2.69 ± 1.25 days in the PVP group. The duration of bed rest was significantly longer in the conservative group than in the PVP group (P < 0.05); however, no significant difference between groups was observed regarding the incidence of complications (P > 0.05) (Table 3). In the conservative group, 6 patients experienced complications. Two patients developed refracture of the treated vertebra at 1 week and 2 months, respectively; both recovered with continued conservative treatment. One patient developed a new vertebral fracture at 14 months and recovered well after PVP. One patient developed a pulmonary infection, and 2 patients developed pressure ulcers. In the PVP group, complications occurred in 4 patients. During the procedure, small amounts of bone cement leaked into the intervertebral disc, perivertebral venous plexus, or surrounding soft tissue in 3 patients. None of these patients experienced symptoms or required additional treatment. One patient developed a new vertebral fracture at 10 months and recovered well after repeat PVP.

Discussion

OVCF is a common age-related condition with an increasing incidence, which poses a substantial threat to the physical and mental health of older adults, particularly postmenopausal women. Treatment goals are to relieve pain, improve mobility and bone density, promote fracture healing, and prevent recurrent fractures. Current treatment options for osteoporotic thoracolumbar fractures include conservative and surgical approaches. Surgical intervention is indicated for patients with unstable fractures linked to neurological injury, persistent pain, severe deformity, or posterior ligament complex injury. However, for patients with mild fractures who lack neurological symptoms, biomechanical instability, or severe pain, the optimal treatment strategy remains controversial [7].

Conventional conservative treatment primarily includes oral anti-osteoporosis medications, physical therapy, bed rest, and functional exercise. However, treatment is prolonged, the complication rate is relatively high, and mortality may increase among older adults [8]. PVP is a minimally invasive procedure that has been widely adopted in recent years. It can be performed under local anesthesia, thus providing rapid pain relief, stabilizing the fractured vertebral body, facilitating early ambulation, and significantly improving clinical outcomes [9–11]. Although the clinical efficacy of PVP has been widely reported, many previous studies were limited by small sample sizes, nonrandomized designs, and relatively low levels of evidence. In 2009, 2 multicenter, randomized, double-blind, placebo-controlled trials published in the New England Journal of Medicine questioned the efficacy of PVP, revealing no significant differences between PVP and control groups in early pain relief or functional improvement [12,13]. Those findings suggested that factors other than bone cement contribute to the observed therapeutic effects. Additionally, some patients included in those studies may not have required surgical treatment because satisfactory outcomes could have been achieved with conservative treatment or even placebo. Nevertheless, surgical intervention remains necessary for selected patients with more severe disease. Thus, appropriate patient selection and careful determination of indications for surgery versus conservative treatment are essential to achieve favorable clinical outcomes. No universally accepted system has been established to comprehensively assess the severity of thoracolumbar osteoporotic fractures or guide treatment selection. Consequently, the lack of clear indications for conservative versus surgical management represents an ongoing challenge in clinical decision-making.

The TLOFSAS was first proposed by Hao et al in 2013 [7,14]. By comprehensively evaluating vertebral morphological changes, magnetic resonance imaging findings, bone mineral density, and clinical manifestations (pain), this system provides a quantitative method for assessing the severity of thoracolumbar osteoporotic fractures. Patients are classified according to their total score, and corresponding treatment recommendations are provided for each category. Previous studies have demonstrated favorable clinical outcomes using this system. The reported diagnostic accuracy, specificity, and sensitivity were 95.7%, 96.5%, and 87.6%, respectively, indicating high reliability and reproducibility [15]. This scoring system is simple to use, comprehensive, and accurate, making it a useful tool for guiding the management of thoracolumbar OVCF. According to the TLOFSAS, conservative treatment is recommended for patients with a score below 4 points. In the present study, all patients had a score of 3 and thus met the criteria for conservative management. Patients were followed for more than 1 year to evaluate changes in clinical outcomes after treatment. However, 13 patients elected to undergo PVP because they wished to achieve earlier mobilization. In these patients, pain was significantly relieved within 1 week after surgery; patients undergoing conservative management did not experience significant pain improvement during the first week after treatment. Statistically significant differences in VAS and ODI scores were observed between the PVP and conservative treatment groups at 1 week and 1 and 3 months after treatment; no significant differences were observed at 6 months or later. This finding may be attributable to fracture healing after approximately 6 months of conservative treatment, which led to substantial reductions in lower back pain and considerable improvement in functional status. The favorable outcomes observed in the conservative treatment group may be better than those reported in most previous studies because all patients in the present cohort had relatively mild osteoporosis, mild fractures, and acute injuries. Additionally, standardized treatment was initiated promptly after admission, contributing to the satisfactory outcomes. Previous high-quality randomized controlled trials have also demonstrated that conservative treatment is an effective management strategy for OVCF [16,17]. In terms of pain relief, PVP has been shown to provide greater reductions in pain than conservative treatment within 1 day and 2 weeks after treatment, indicating superior short-term analgesic efficacy. However, no significant differences have been observed between these treatments at 3 and 12 months [18]. Diamond et al compared PVP and conservative treatment in patients with OVCF; they found that PVP provided more rapid pain relief and substantially shortened the time to functional recovery [18]. Although the long-term efficacies of the treatments were comparable, PVP was associated with higher treatment costs. Therefore, the overall clinical benefit of PVP requires further evaluation, consistent with the present findings. Similarly, Wang et al conducted a prospective nonrandomized controlled study, revealing that PVP produced immediate and significant improvements in pain relief, physical function, and medication requirements compared with conservative management [19]. The present results are consistent with those of several previous large-scale meta-analyses, demonstrating that PVP offers substantial short-term advantages over conservative treatment but no long-term superiority [20,21]. Thus, careful patient selection for each treatment strategy is essential to achieve optimal clinical outcomes. In addition to clinical indications, factors such as patient preferences, expectations regarding short-term quality of life, and direct medical costs should be considered when developing individualized treatment plans. Our findings may assist clinicians in selecting appropriate treatment strategies and improving patient outcomes. Most prior studies have solely focused on surgical indications. A strength of the present study is its broader approach to treatment planning, which incorporates both surgical indications and individualized factors, such as patient preferences. This more comprehensive approach has been largely absent from previous research. Generally, the risk of complications is expected to increase with prolonged bed rest. However, our findings did not support this assumption. Although the conservative treatment group had a significantly longer duration of bed rest than the PVP group, no significant difference in complication rates was observed between the groups. This finding differs from the results of most previous studies [2,22] and may be attributable to the strict selection criteria, relatively small sample size, and limited follow-up duration. Moreover, the incidences of bone cement leakage and adjacent vertebral fractures were lower than those reported in previous large-scale studies [23,24], which may also be related to the small sample size and rigorous anti-osteoporosis treatment used in the present study.

This study has several limitations that should be acknowledged. First, given its retrospective observational design, the study is inherently subject to selection bias because participants were not randomly assigned to treatment groups. The lack of randomization may have introduced systematic differences between groups, potentially affecting the validity of the findings. Second, the study included a relatively small sample of only 55 patients, which may have constrained the statistical power, reliability, and generalizability of the results. Additionally, enrollment was restricted to patients with mild OVCF and a TLOFSAS score of 3. Therefore, the findings are applicable only to this specific subgroup and should not be extrapolated to patients with more severe OVCF or multilevel vertebral fractures. Third, unmeasured confounding factors, such as pretreatment analgesic use and baseline activity levels, may have influenced the results because these variables were not systematically collected or adjusted for in the analysis. Fourth, this was a single-center study, limiting the diversity of the study population and potentially reducing the generalizability of the findings to other geographic regions or clinical settings. Finally, the follow-up period was insufficient to evaluate long-term treatment efficacy and the incidence of late complications. A longer follow-up period is needed to better establish the durability of treatment benefits and the long-term safety profile of both treatment strategies. Future studies should utilize multicenter, prospective designs with larger sample sizes to address these limitations.

Conclusions

Both PVP and conservative treatment relieved pain and improved quality of life in patients with OVCF. Compared with conservative treatment, PVP provided superior early pain relief and faster functional recovery. Although patients in the conservative treatment group experienced slower symptom improvement and requ\ired a longer duration of bed rest, long-term clinical outcomes and complication rates were comparable between groups. Large-scale, multicenter randomized controlled trials are needed to validate these findings and improve their generalizability.