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Purpose To compare vertebroplasty (VP) and kyphoplasty (KP) with a titanium implantable vertebral augmentation device (TIVAD) in symptomatic subsequent vertebral compression fracture (SVCF) incidence among osteoporotic vertebral compression fracture (OVCF) patients stratified by age and sex. Methods This retrospective cohort study involved OVCF patients aged ≥ 50, who underwent KP with TIVAD or VP in our hospital from 2014 to 2019. Subgroup analysis was conducted to evaluate the efficacy of KP with TIVAD and VP in patients stratified by age and sex. Results The study included 472 patients (VP group: 303; TIVAD group: 169). SVCF incidence rates were 15.2% for VP group and 14.8% for TIVAD group ( P  = 0.87). In subgroup analysis, TIVAD group showed significantly lower SVCF incidence than VP group in women aged 50–70 (2.1% vs 14.3%; P  = 0.03) and had significantly higher SVCF incidence than VP group in women aged > 70 (24.2% vs 13.1%; P  = 0.02). In men, adjacent SVCF incidence was significantly lower in TIVAD group than VP group (0% vs 14.1%; P  = 0.03). Conclusion Compared to VP, TIVAD is associated with lower symptomatic SVCF rate in men and younger women aged 50–70 but not in older women aged > 70. Age and gender may influence SVCF incidence. Level of evidence Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.

SummaryAdjacent vertebral compression fracture (AVCF) is the primary factor affecting satisfaction after PKP surgery. In addition to osteoporosis, certain structural characteristics of the vertebral body itself also increase their risk. The purpose of this study was to explore the impact of biomechanical changes on AVCF after balancing other factors.IntroductionAs a routine treatment of OVCF, the postoperative refracture of PKP is a serious problem. The aim of our study was to explore the impact of lumbar biomechanical changes on the risk of AVCF. A propensity score matching was performed to balance the interference of osteoporosis, which is the primary risk factor of AVCF.MethodsA retrospective, single-center case–control study was performed. From September 2013 to March 2020, 1752 patients were enrolled, and AVCF was assessed in 80 of these patients. A propensity score matching (PSM) analysis was performed, and 5 potential confounding factors were matched (age, BMI, number of fractured vertebral bodies, fracture region, and HDL). The preoperative and postoperative radiological factors were measured in the matched cohort of 48 pairs. A conditional logistic regression analysis to adjust the comparative risks.ResultsThe preoperative wedge angle and its postoperative recovery of the AVCF group were significantly higher than that of the non-AVCF group. The local kyphosis of the fractured vertebral body between the two groups was similar, but the recovery in the AVCF group was slightly higher than that in the non-AVCF group. The preoperative and postoperative relative anterior height (RAH) of the fractured vertebral body was familiar in two groups, so was the recovery of RAH. The preoperative spino-sacral angle (SSA) was significantly higher in the AVCF group than in the non-AVCF group. The preoperative wedge angle was identified as the only significant risk factor for AVCF in the multivariate analysis.ConclusionIn conclusion, a larger preoperative fracture vertebral wedge angle is a risk factor for AVCF. For such high-risk patients, surgeons should be cautious about surgical decisions. The postoperative active measures and tailored surveillance should be attached to great importance as well.

Introduction New vertebral compression fractures (NVCFs) are adverse events after vertebral augmentation of osteoporotic vertebral compression fractures (OVCFs). Predicting the risk of vertebral compression fractures (VCFs) accurately after surgery is still a significant challenge for spinal surgeons. The aim of our study was to identify risk factors of NCVFs after vertebral augmentation of OVCFs and develop a nomogram. Methods We retrospectively reviewed the medical records of patients with OVCFs who underwent percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP). Patients were divided into the NVCFs group and control group, base on the patients with or without NVCFs within 2 years follow-up period after surgery. A training cohort of 403 patients diagnosed in our hospital from June 2014 to December 2016 was used for model development. The independent predictive factors of postoperative VCFs were determined by least absolute shrinkage and selection operator (LASSO) logistic regression, univariate analysis and multivariate logistic regression analysis. We provided a nomogram for predicting the risk of NVCFs based on independent predictive factors and used the receiver operating characteristic curve (ROC), calibration curve, and decision curve analyses (DCA) to evaluated the prognostic performance. After internal validation, the nomogram was further evaluated in a validation cohort of 159 patients included between January 2017 and June 2018. Results Of the 403 patients in the training cohort, 49(12.16%) were NVCFs at an average of 16.7 (1 to 23) months within the 2 years follow-up period. Of the 159 patients in the validation cohort, 17(10.69%) were NVCFs at an average of 8.7 (1 to 15) months within the 2 years follow-up period. In the training cohort, the proportions of elderly patients older than 80 years were 32.65 and 13.56% in the NVCFs and control group, respectively ( p  = 0.003). The percentages of patients with previous fracture history were 26.53 and 12.71% in the NVCFs and control group, respectively ( p  = 0.010). The volume of bone cement were 4.43 ± 0.88 mL and 4.02 ± 1.13 mL in the NVCFs and Control group, respectively ( p  = 0.014). The differences have statistical significance in the bone cement leakage, bone cement dispersion, contact with endplate, anti-osteoporotic treatment, post-op Cobb angle and Cobb angle restoration characteristics between the two groups. The model was established by multivariate logistic regression analysis to obtain independent predictors. In the training and validation cohort, the AUC of the nomogram were 0.882 (95% confidence interval (CI), 0.824-0.940) and 0.869 (95% CI: 0.811-0.927), respectively. The C index of the nomogram was 0.886 in the training cohort and 0.893 in the validation cohort, demonstrating good discrimination. In the training and validation cohort, the optimal calibration curves demonstrated the coincidence between prediction and actual status, and the decision curve analysis demonstrated that the full model had the highest clinical net benefit across the entire range of threshold probabilities. Conclusion A nomogram for predicting NVCFs after vertebral augmentation was established and validated. For patients evaluated by this model with predictive high risk of developing postoperative VCFs, postoperative management strategies such as enhance osteoporosis-related health education and management should be considered.

SummaryPatients with Parkinson’s disease (PD) were at higher risk of osteoporotic vertebral compression fractures (OVCF) compared to controls and had elevated mortality rates. Compared to conservative treatment, surgical treatment for OVCF in PD patients seemed to be associated with better outcomes.IntroductionThe purpose of this study was to evaluate the risk of OVCF in patients with PD.MethodsData from patients over the age of 60 years who were diagnosed with PD were collected between 2004 and 2013 from the Korean National Health Insurance Database (n = 3370). The comparison group (non-PD) consisted of randomly selected patients (five per patient with PD; n = 16,850) matched to the PD group, who were newly diagnosed annually according to age and sex. Cox proportional hazard regressions were used to examine the relationships between osteoporosis, OVCF, surgery for OVCF, and PD. Household income and residential area of patients were also assessed. Overall survival rates were calculated after adjusting for confounding factors, such as hypertension, diabetes mellitus, and chronic kidney disease.ResultsOVCF was developed in 12.5% of patients in the PD group and in 7.4% of patients in the control group. PD was associated with increased risk of osteoporosis (hazard ratio [HR], 1.32; 95% confidence interval [CI], 1.21–1.43; p < 0.001), OVCF (HR 1.66; 95% CI, 1.47–1.87; p < 0.001), and surgery for OVCF (HR 2.69; 95% CI, 1.78–4.08; p < 0.001). Household income was not significantly related with development of osteoporosis, incidence of OVCF, or surgery for OVCF. Residential area was statistically associated with osteoporosis, OVCF, and surgery for OVCF. The mortality rate of the PD group was about 1.7 times higher than that of the non-PD group after adjusting for potential confounders, and the mortality rate of the PD with OVCF group was higher than that of the non-PD group, but not significantly (p = 0.09). The survival rate of the PD group with surgery for OVCF showed a trend toward a more positive prognosis compared with that of the PD group with conservative treatment.ConclusionsPatients with PD had significantly increased risk of osteoporosis and OVCF. Surgical treatment for OVCF in PD patients was associated with a better prognosis than conservative treatment.

Percutaneous kyphoplasty (PKP) is one of the primary treatment options for osteoporotic vertebral compression fractures (OVCF). New vertebral compression fractures (NVCF) are common complications following PKP. This study aims to identify risk factors associated with NVCF after PKP and to develop a simple and user-friendly predictive model to assist clinicians in decision-making. A retrospective cohort study was conducted, analyzing clinical data from 340 patients with single-segment OVCF who underwent PKP at our institution between January 2020 and December 2022. We collected general clinical data and imaging findings from patients who underwent PKP at our institution. Lasso regression was employed to identify risk factors for NVCF after PKP, and the selected variables were further analyzed using an unrestricted cubic spline function. Finally, a predictive model was established using multivariate logistic regression analysis. The variables selected by Lasso regression included pre-op AVH (OR = 0.853) and vertebral height restoration rate (OR = 4.318). Restricted cubic spline function analysis demonstrated that patients with a pre-op AVH of less than 19.2 mm had a significantly increased risk of NVCF after PKP. Pre-op AVH and anterior vertebral height restoration rate are independent risk factors for NVCF after PKP. The predictive model constructed based on these two independent risk factors can effectively assess the risk of NVCF in elderly patients with OVCF undergoing PKP, providing valuable guidance for clinical decision-making.

To evaluate the risk factors for adjacent vertebral compression fracture(AVCF) following the surgery of percutaneous kyphoplasty (PKP) in postmenopausal women. Two hundred and ninety-seven postmenopausal female patients had been reviewed, underwent PKP surgery between January 2016 and December 2020, were divided into two groups according to whether or not AVCF. Receiver operating characteristic (ROC) curves were generated to analyze the sensitivity and specificity of the relative risk factors in the identification of AVCF. In this study of 297 postmenopausal women who underwent PKP, 67 developed AVCF during follow-up. There were no significant differences in BMI, surgical method, or cement leakage between the groups. The AVCF group was older, had lower BMD, less bone cement volume per section, higher VHA, and larger VKAC. The non-fracture group had lower postoperative VAS and fewer surgical vertebrae. The model showed good discrimination with age, BMD, postoperative VAS, VHR, and VKAC. ROC analysis indicated that a postoperative with high VHR, high VKAC or VAS score > 2.5 was highly predictive of AVCF in postmenopausal women after PKP. In the context of PKP for OVCF in postmenopausal women, it is crucial to avoid excessive VHR and VKAC. Postoperatively, clinicians should prioritize pain management strategies to ensure optimal patient outcomes.

Purpose New vertebral compression fractures(NVCFs) after minimally invasive surgery in patients with osteoporotic vertebral compression fracture (OVCF) is a challenging issue worldwide. Predicting the occurrence of NVCFs is key to addressing such questions. Therefore, we aimed to investigate the risk factors for patients who developed NVCFs after undergoing surgical treatment and establish a nomogram model to reduce the occurrence of NVCFs. Methods This study is a retrospective analysis that collected the general characteristics and surgical features of patients who underwent surgical treatment at 2 central institutions between January 2017 and December 2020. Patients were divided into training and testing sets based on the presence or absence of NVCFs. Independent risk factors for NVCFs were obtained in the training set of patients, and then a nomogram model was constructed. Internal and external validation of the nomogram model was performed using the consistency index (C index), receiver operating characteristic curve(ROC), calibration curves, and decision curve analysis (DCA). Results A total of 562 patients were included in this study. Patients from the first center were used for nomogram construction and internal validation, and patients from the second center were used as an external validation population. Multivariate regression analysis showed that age, Hounsfield unit (Hu) value, cement leakage, and thoracolumbar (TL) junction fracture were independent risk factors for NVCFs after minimally invasive surgery. The C index was .85, and the validation of internal and external validation shows that the predicted values of the established model is in good agreement with the actual values. Conclusions In this study, 4 independent risk factors were obtained by regression analysis, and a nomogram model was constructed to guide clinical work. The application of this model can help surgeons to make more accurate judgments to prevent the occurrence of NVCFs.

This study aimed to investigate the risk factors for surgical site infection (SSI) after percutaneous kyphoplasty (PKP) and evaluate the application value of the preoperative C-reactive protein (CRP)-to-albumin ratio (CAR) in predicting SSI. This study retrospectively enrolled 329 patients with thoracolumbar compression fractures who underwent PKP in the Affiliated Hospital of Qingdao University from January 2019 to June 2024. The demographic information, surgery-related data and laboratory examination results of the patients were collected. According to these results, the patients were divided into SSI and non-SSI groups, and the results were compared and analyzed. The receiver operating characteristic curve was used to determine the optimal cutoff value of preoperative CAR for predicting SSI, and binary logistic regression analysis was employed to evaluate the predictive value of CAR for SSI. The risk factors of SSI in the thoracolumbar subgroup were further explored. The study enrolled a total of 329 patients, and SSI occurred in 29 (8.81%). The optimal cut-off value of CAR was 0.1213, and the area under the curve was 0.808 (P < 0. 001). The results showed that SSI rates were related to the surgical site, and the SSI rate in the lumbar spine was higher than that in the thoracic spine. The SSI group had a longer surgical duration and more operated segments. The levels of preoperative CRP, CAR, procalcitonin and erythrocyte sedimentation rate (ESR) were higher; however, serum albumin levels were lower. More patients had CAR ≥0.1213 (75.86% vs 25.33%) and white blood cell (WBC) >10*10 (27.59% vs 10.00%). In addition, no significant differences were found by the other demographic data and laboratory examinations between the two groups. In the binary logistic regression analysis, preoperative CAR was an independent risk factor for post-PKP SSI, and the SSI risk increased by 7.464 times in patients with CAR ≥0.1213. The number of operated segments, surgical duration, and ESR were also independent risk factors for SSI, whereas serum albumin is a protective factor. Preoperative CAR is an effective predictor of post-PKP SSI, which can be used for clinical prevention and reduction of SSI risk.

Adjacent disc degeneration (ADD) is a common postoperative complication after percutaneous kyphoplasty (PKP). However, risk factors for ADD after PKP have not been reported. This study aimed to determine whether osteoporotic vertebral compression fracture (OVCF) following PKP is associated with a high risk for ADD and to identify the risk factors for ADD. Consecutive patients who underwent PKP at our center between January 2015 and January 2021 were retrospectively reviewed. The incidence of ADD was calculated and specific subgroups of ADD were identified. Demographic, clinical baseline, and radiologic data were analyzed using univariate and multivariate analyses to identify the risk factors associated with ADD. 130 eligible patients were included, and the incidence rate of ADD distinct from primary degeneration was 42.3%. Patients with OVCFs who underwent PKP had a high risk of developing ADD. The independent risk factors included the presence of intradiscal cement leakage (ICL; odds ratio [OR] 6.292; 95% confidence interval [CI] 2.588-15.299; < 0.001) and pre-operative cranial disc of the injured vertebrae degeneration (Pfirrmann grade ≥IV; OR 3.575; 95% CI 1.515-8.438; = 0.004). Patients with OVCFs who underwent PKP were more likely to develop ADD, and most of the degenerated discs occurred in the vertebrae above the level of injury. ICL and pre-operative cranial disc of the injured vertebrae degeneration (Pfirrmann grade ≥IV) were independent risk factors for developing ADD in these patients.

Background New vertebral compression fractures (NVCFs) are common adverse events in percutaneous kyphoplasty (PKP). The present study aimed to investigate the risk factors for NVCFs in patients after PKP and to construct a nomogram for the prediction of the risk of re-fracture. Methods We retrospectively analyzed the medical records of patients after PKP surgery between January 2017 and December 2020. Patients were divided into an NVCF group (n = 225) and a control group (n = 94) based on the presence or absence of NVCFs, respectively, at follow-up within 2 years after surgery. Lasso regression was used to screen for risk factors for re-fracture. Based on the results, a Lasso-logistic regression model was developed, and its prediction performance was evaluated using receiver operating characteristic curves, calibration, and decision curve analysis. The model was visualized, and a nomogram was constructed. Results A total of eight potential predictors were obtained from Lasso screening. Advanced age, low body mass index, low bone mineral density, lack of anti-osteoporosis treatment, low preoperative vertebral body height, vertebral body height recovery ≥ 2, cement leakage, and shape D (lack of simultaneous contact of bone cement with the upper and lower plates) were included in the logistic regression model. Conclusions A nomogram for predicting postoperative NVCF in PKP was developed and validated. This model can be used for rational assessment of the magnitude of the risk of developing NVCFs after PKP, and can help orthopedic surgeons make clinical decisions aimed at reducing the occurrence of NVCFs.