Analysis of risk factors for adjacent vertebral fractures after percutaneous vertebroplasty for osteoporotic vertebral compression fractures

English Keywords:Osteoporotic vertebral compression fracture  Adjacent vertebral fracture  Superior endplate fracture  Percutaneous vertebroplasty  Risk factors

English Abstract:

  【Abstract】 Objectives: To explore the incidence and risk factors of adjacent vertebral fractures(AVF) in patients with osteoporotic vertebral compression fractures(OVCF) after percutaneous vertebroplasty(PVP) treatment. Methods: A retrospective analysis was conducted on 482 OVCF patients who underwent PVP at our hospital from June 2017 to January 2022. There were 146 males and 336 females, with an average age of 68.4±3.1 years(63-86 years). The average follow-up time was 42.9±10.2 months(24-70 months). Based on whether AVF occurred during the follow-up period, the patients were divided into an AVF group and a non-AVF group. The time of AVF occurrence was recorded, and the incidence rate of AVF was calculated using the Kaplan-Meier method to obtain a survival curve. Intergroup comparisons were made in terms of clinical factors including gender, age, body mass index(BMI), adjacent vertebral CT value, and bone metabolism related indexes[total procollagen type Ⅰ N-terminal propeptide(tPⅠNP), β-cross-linked C-telopeptide of type Ⅰ collagen(β-CTX), and 25-hydroxyvitamin D(25-OHD)]; Imaging factors such as whether the fracture was located in the thoracolumbar segment, whether it was accompanied by an upper endplate fracture, whether it was accompanied by an intravertebral vacuum cleft(IVC), preoperative vertebral body height, wedge angle, and kyphosis angle; And surgical factors including bone cement injection volume, postoperative restoration of vertebral height, restoration of wedge angle, restoration of kyphosis angle and whether bone cement leakage occurred. Indicators that were significant in the univariate analysis were included in the multivariate logistic regression analysis. Results: AVF occurred in 47 cases(9.75%) in 17.9±14.7 months(1-55 months) after PVP. The Kaplan-Meier survival curve showed that the incidence of AVF in the group with upper endplate fractures was significantly higher than that in the group without upper endplate fractures(P<0.001). There were no statistically significant differences between the AVF group and the non-AVF group in terms of gender, BMI, tPⅠNP, β-CTX, 25-OHD, preoperative vertebral body height, wedge angle, kyphosis angle, bone cement injection volume, postoperative restoration of vertebral height, restoration of wedge angle and restoration of kyphosis angle(P>0.05). Statistically significant differences were found in age, adjacent vertebral CT value, whether the fracture was located in the thoracolumbar segment, whether it was accompanied by an upper endplate fracture, whether it was accompanied by an IVC, and whether bone cement leakage occurred(P<0.05). Further multivariate logistic regression analysis showed that advanced age(OR=1.187, 95%CI=1.084-1.300, P<0.001), low CT value of adjacent vertebra(OR=0.928, 95%CI=0.892-0.964, P<0.001), presence of upper endplate fracture(OR=3.514, 95% CI=1.444-8.551, P=0.006), presence of IVC(OR=2.804, 95%CI=1.238-6.349, P=0.013), and bone cement leakage(OR=2.415, 95%CI=1.134-5.146, P=0.022) were the risk factors for AVF after PVP. Conclusions: Advanced age, low CT value of adjacent vertebra, upper endplate fracture, IVC, and bone cement leakage are the independent risk factors for postoperative AVF in OVCF patients undergoing PVP.