Objective: To compare the 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 whether the preoperative local Cobb angle can guide risk stratification for surgical decision-making. Methods: This two-center retrospective study included 117 patients with stage III KD without neurological deficits who underwent surgery between January 2019 and December 2024. Among them, 71 underwent PKP and 46 underwent SSF+VP. Perioperative parameters, VAS, ODI, local Cobb angle, Cobb angle loss, cement distribution, and cement leakage were compared. In this exploratory analysis, residual mild pain was defined as a final follow-up VAS ≥2. In the PKP group, the association between Cobb angle loss and final follow-up VAS was analyzed. ROC analysis was performed to assess the predictive value of the preoperative Cobb angle for residual mild pain after PKP. Patients were further stratified according to the optimal preoperative Cobb angle cut-off, and 2,000 bootstrap resamples were used for internal validation. Results: Baseline characteristics were comparable. PKP was associated with shorter operative time, less blood loss, smaller cement volume, shorter hospital stay, and greater early VAS and ODI improvement than SSF+VP. However, at final follow-up, SSF+VP showed lower VAS, while ODI was comparable. Radiographically, SSF+VP achieved lower postoperative and final Cobb angles, less Cobb angle loss, more diffuse cement distribution, and less cement leakage. In the PKP group, Cobb angle loss correlated positively with final VAS (rho=0.542, p < 0.001). The preoperative Cobb angle predicted residual pain after PKP, with an optimal cut-off of 25.95°. After stratification, final VAS did not differ between procedures in the mild-moderate kyphosis subgroup, whereas SSF+VP showed better intermediate-term pain outcomes in the severe kyphosis subgroup. Bootstrap validation supported the stability of this risk-stratified finding. Conclusion: Both PKP and SSF+VP improved pain and function in stage III KD without neurological deficits. PKP enabled faster early recovery, whereas SSF+VP provided better correction maintenance and intermediate-term pain outcomes in patients with severe preoperative kyphosis. Preoperative Cobb angle-based stratification may help guide individualized surgical selection.

Background: Arthritis and rheumatic diseases frequently co-occur with depressive symptoms in middle-aged and older adults. However, most previous studies have relied on total depression scores and have paid less attention to symptom-level associations. This study aimed to examine population-level and symptom-level associations between arthritis/rheumatism and depressive symptoms. Methods: Data were drawn from 15,721 adults aged ≥ 45 years from the 2018 wave of the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative survey in China. Hierarchical linear regression analyses were used to examine the associations between arthritis/rheumatism and depressive symptoms. Network analysis was used to estimate symptom-level networks and compare depressive symptom networks between participants with and without arthritis/rheumatism. Results: After adjustment for sociodemographic and health-related covariates, arthritis/rheumatism remained significantly associated with higher depressive symptom levels (β = 0.07, p < 0.001). Network analysis showed that depressed mood and perceived effort were the most central symptoms, while restless sleep and perceived effort showed the strongest bridge connections with arthritis/rheumatism. Network comparison analyses indicated no significant differences in global network structure or global strength between participants with and without arthritis/rheumatism. However, four symptom connections were significantly stronger, and low hope showed reduced centrality in participants with arthritis/rheumatism. Conclusions: Arthritis/rheumatism was associated with greater depressive symptom burden and with specific symptom-level connections involving sleep disturbance and perceived effort. These findings highlight the potential value of screening for sleep problems and effort-related symptoms in adults with arthritis/rheumatism.