Objective:

To compare clinical and radiographic outcomes of percutaneous kyphoplasty (PKP) and short-segment fixation with vertebroplasty (SSF+VP) in patients with stage III Kümmell disease (KD) without neurological deficits, and to evaluate the preoperative local Cobb angle for guiding surgical decision-making.

Approach:

• Study Design: A two-center retrospective study involving 117 patients who underwent surgery between January 2019 and December 2024.
• Patient Groups: 71 patients underwent PKP and 46 underwent SSF+VP.
• Data Collected: Perioperative parameters, VAS, ODI, local Cobb angle, Cobb angle loss, cement distribution, and cement leakage were compared.
• Analysis Methods: ROC analysis assessed the predictive value of the preoperative Cobb angle for residual mild pain after PKP.

Key Findings:

• PKP resulted in shorter operative time, less blood loss, smaller cement volume, and greater early improvement in VAS and ODI compared to SSF+VP.
• SSF+VP showed lower VAS at final follow-up and better maintenance of Cobb angle correction.
• Cobb angle loss in the PKP group correlated positively with final VAS.
• The optimal preoperative Cobb angle cut-off for predicting residual pain after PKP was 25.95°.

Interpretation:

Both PKP and SSF+VP improved pain and function in stage III KD without neurological deficits, with PKP allowing faster early recovery and SSF+VP providing better long-term outcomes in severe kyphosis cases.

Limitations:

• The study is retrospective and may have inherent biases related to patient selection and data collection.
• The sample size may limit the generalizability of the findings.

Conclusion:

Preoperative Cobb angle-based stratification may assist in guiding individualized surgical selection for patients with stage III KD.