The Use of Polymethylmethacrylate Cement in Percutaneous Vertebroplasty Versus Conservative Management: How to Treat Osteoporotic Vertebral Compression Fractures

Background and Objectives: Osteoporotic vertebral compression fractures (OVCFs) are a major cause of morbidity, disability, and loss of independence in the elderly population. The optimal management of these fractures remains debated, especially regarding the balance between conservative treatment and minimally invasive surgical techniques such as percutaneous vertebroplasty (VP). This study aimed to compare clinical and radiological outcomes of VP and conservative management in patients with acute OVCFs. Materials and methods: A retrospective observational cohort study was conducted on 120 patients with acute OVCFs treated either conservatively or through percutaneous VP using polymethylmethacrylate (PMMA) cement. Clinical outcomes were assessed using the Visual Analogue Scale (VAS) for pain, Roland-Morris Disability Questionnaire (RMDQ), and Oswestry Disability Index (ODI). Evaluations were performed at baseline and at 1, 3, 6, and 12 months post-treatment. Radiological follow-up assessed fracture healing and new vertebral fractures. Results: Patients treated with VP experienced significantly faster pain relief and functional improvement than those managed conservatively, with marked differences in VAS, RMDQ, and ODI scores within the first month (p < 0.01). By 12 months, outcomes converged between groups, with comparable pain and functional levels. No major complications were reported; cement leakage was asymptomatic, and no neurological or systemic adverse events occurred. Radiological healing was satisfactory in both groups, without increased risk of adjacent fractures in the VP group. Conclusions: Percutaneous vertebroplasty resulted in faster short-term improvement compared with conservative treatment, while functional outcomes converged over time. The retrospective, non-randomized design limits causal inference.