Percutaneous vertebroplasty via Kambin’s triangle for osteoporotic vertebral compression fractures in patients with spinal deformity: a retrospective comparative study

To evaluate the clinical outcomes of percutaneous vertebroplasty (PVP) via Kambin’s triangle in older patients with spinal deformity and osteoporotic vertebral compression fractures (OVCFs). We retrospectively reviewed 31 patients with spinal deformity and OVCFs treated between January 2019 and December 2022. The cohort comprised 13 men and 18 women aged 60–84 years (mean, 70 ± 10.3 years), with symptom durations of 1–6 weeks (mean, 3.5 ± 1.7 weeks). Thirty-five vertebrae were treated. Fifteen patients (17 vertebrae) underwent unilateral PVP via Kambin’s triangle, whereas 16 patients (18 vertebrae) underwent unilateral transpedicular PVP. Patient-level outcomes included VAS, ODI, and complications; vertebra-level outcomes included operative time, fluoroscopic acquisitions, cement leakage, and cement distribution. A total of 31 patients with 35 treated vertebrae were included. Group A comprised 15 patients with 17 treated vertebrae, and Group B comprised 16 patients with 18 treated vertebrae. Mean operative time was 25 ± 5.7 min per vertebra in Group A and 33 ± 7.2 min per vertebra in Group B. Mean fluoroscopic acquisitions were 6.2 ± 1.6 and 9.3 ± 1.8 per vertebra, respectively. After Bonferroni correction, operative time (adjusted P = 0.019) and fluoroscopic acquisitions (adjusted P < 0.001) remained statistically significant. Cement leakage occurred in 0 of 17 treated vertebrae in Group A and 2 of 18 treated vertebrae in Group B. Uniform cement dispersion was observed in 12 of 17 vertebrae (70.59%) in Group A and 6 of 18 vertebrae (33.33%) in Group B; however, this difference was not statistically significant after Bonferroni correction (adjusted P = 0.437) and was considered exploratory. Both approaches were associated with improvement in pain and disability. In selected patients with L1–L3 OVCFs and spinal deformity in whom conventional transpedicular access is anatomically difficult, PVP via Kambin’s triangle may be a feasible alternative. Preliminary findings suggest associations with shorter operative time and fewer fluoroscopic acquisitions, but larger prospective studies are required. These exploratory associations do not establish that the Kambin’s-triangle trajectory itself confers a technical advantage, because anatomical case selection and baseline differences may have contributed.