Assessing the Role of Expandable Vertebral Augmentation (EVA) versus high-viscosity cement vertebroplasty (HVCV) in Severe Osteoporotic Vertebral Fracture Management: A Prospective Cohort Study

Yi-Chen Liu; You-Rui Lin; Sung Huang Laurent Tsai; Ying-Chih Wang; Chia-Wei Chang; Tung-Yi Lin; Tsai-Sheng Fu; Wen-Jer Chen

doi:10.1016/j.wneu.2025.124166

Assessing the Role of Expandable Vertebral Augmentation (EVA) versus high-viscosity cement vertebroplasty (HVCV) in Severe Osteoporotic Vertebral Fracture Management: A Prospective Cohort Study

World Neurosurg. 2025 Jun 12:124166. doi: 10.1016/j.wneu.2025.124166. Online ahead of print.

Authors

Yi-Chen Liu¹, You-Rui Lin¹, Sung Huang Laurent Tsai², Ying-Chih Wang¹, Chia-Wei Chang¹, Tung-Yi Lin¹, Tsai-Sheng Fu³, Wen-Jer Chen⁴

Affiliations

¹ Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, and School of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
² Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, and School of Medicine, Chang Gung University, Taoyuan 333, Taiwan; Department of Orthopedics, Taipei Medical University Hospital, Taipei, Taiwan; Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Biomedical Engineering, National Taiwan University, Taipei 10617, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taiwan. Electronic address: laurenttsai@gmail.com.
³ Department of Orthopaedic Surgery, Spine Division, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan, ROC.
⁴ Department of Orthopaedic Surgery, Chung Shan Hospital, Taipei 106, Taiwan, ROC.

PMID: 40516601
DOI: 10.1016/j.wneu.2025.124166

Abstract

Objective: This study aimed to compare the efficacy of Expandable Vertebral Augmentation (EVA) versus High-Viscosity Cement Vertebroplasty (HVCV) in patients with severe osteoporotic vertebral compression fractures (OVCFs) to determine which intervention offers superior benefits.

Materials and methods: This prospective cohort study enrolled symptomatic osteoporotic compression fracture patients from a single center in Taiwan between 2018 and 2020, all of whom presented with a loss of body height exceeding 40%. Patients were allocated to either the EVA or HVCV group. The primary outcome measure was radiographic assessment, including vertebral body height restoration and kyphotic angle correction at 12 months postoperatively. The secondary outcomes included the incidence of adjacent fractures and cement leakage.

Results: In this prospective cohort study, a total of 98 patients were allocated to the EVA (46 cases) or HVCV (52 cases) group; the cohort had a mean age of 77.1 years, with women accounting for 77 % of participants.; the cohort had a mean age of 77.1 years, with women accounting for 77 % of participants. Radiographic outcomes demonstrated that the EVA group experienced a significantly greater improvement in vertebral body height and kyphotic angle (mean improvement, 64.0%) than the HVCV group (mean improvement, 40.4%). The incidence of postoperative complications such as adjacent fractures and cement leakage did not differ significantly between the groups (p>0.05), indicating comparable safety profiles.

Conclusion: Our findings indicate that the EVA group is superior than the HVCV group for vertebral height restoration and kyphotic angle correction, with both techniques showing effective management and safety profiles.

Keywords: Expandable Vertebral Augmentation; High Viscosity Cement Vertebroplasty; Kyphotic Angle; Osteoporotic Vertebral Compression Fracture; Vertebral Body Height.