Abstract
The optimal cement diffusion pattern in unilateral percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fractures (OVCFs) remains debated. This multicenter retrospective study investigated whether crossing the vertebral midline with bone cement is necessary under the DGOU classification. A total of 440 patients with single-level OVCFs treated by unilateral PKP (2020–2023) were categorized into OF1, OF2, or OF3 types based on the DGOU classification and further divided into crossing and non-crossing groups according to postoperative CT. Outcomes included VAS, ODI, and radiographic parameters. In OF1 fractures, no significant differences were observed between the two groups. However, for OF2 and OF3 fractures, the crossing group demonstrated significantly better ODI scores at 6 and 12 months (P < 0.001) and improved vertebral height maintenance (P < 0.001), without increasing complications. These findings suggest that achieving cross-midline cement diffusion may not be necessary for stable OF1 fractures, but it is associated with significantly better mid- to long-term functional and radiographic outcomes in unstable OF2/OF3 fracture types.
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Funding
The Ningxia Natural Science Foundation (2023AAC03543, 2024AAC05082, 2025AAC030812), 2024 Ningxia Hui Autonomous Region key research and development plan to introduce special projects(2024BEH04159).
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Author Contributions: D.C. : study concept and design, and desk review. X.L. : initial writing. W.G. : methodology. Z.L. : validation. X.Z. : formal analysis. Y.T. : statistical analysis. Y.Y. : revision of the manuscript. H.Z. : data curation. H.M. : statistical support. H.Z. : data curation. B.F. : writing - original draft. T.N. : visualization. Y.N. & P.M. : revision of manuscript. X.Z. : project administration. H.Y. : primary writing, revision of the manuscript, study concept and design, statistical support, and critical revision of the manuscript. All authors have made substantive contributions to this study and manuscript, and all have reviewed the final paper before its submission.
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All patients provided written informed consent for the surgical procedure (PKP) and associated standard postoperative care, including follow-up imaging. For the retrospective analysis of anonymized data from these routine clinical records, specific informed consent was waived by the Ethics Review Committee of Ningxia Medical University General Hospital.
Institutional review board statement
All procedures were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the Ethics Committee of Ningxia Medical University General Hospital (KYLL-2025-2434). All imaging data were obtained with the informed consent of the patients.
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Cao, D., Li, X., Gu, W. et al. DGOU classification guided cement diffusion strategy in unilateral kyphoplasty for osteoporotic vertebral compression fractures. Sci Rep (2026). https://doi.org/10.1038/s41598-026-40167-5
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DOI: https://doi.org/10.1038/s41598-026-40167-5
