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Assessment of clinical, imaging, surgical risk factors for subsequent fracture following vertebral augmentation in osteoporotic patients

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Abstract

Introduction

Currently, the risk factors for subsequent fracture following vertebral augmentation remain incomplete and controversial. To provide clinicians with accurate information for developing a preventive strategy, we carried out a comprehensive evaluation of previously controversial and unexplored risk factors.

Methods

We retrospectively reviewed patients with osteoporotic vertebral compression fracture in lumbar spine who received vertebral augmentation between January 2019 and December 2020. Based on whether refracture occurred, patients were assigned to refracture and non-refracture group. The clinical characteristics, imaging parameters (severity of vertebral compression, spinal sagittal alignment, degeneration of paraspinal muscles), and surgical indicators (cement distribution and leakage, correction of spinal sagittal alignment) were collected and analyzed.

Results

There were 128 patients and 16 patients in non-refracture and refracture group. The incidence of previous fracture, multiple fractures, and cement leakage were notably higher, relative cross-sectional area of psoas (r-CSAPS) was significantly smaller, CSA ratio, fatty infiltration of erector spinae plus multifidus (FIES+MF), FIPS, postoperative lumbar lordosis (post-LL), correction of body angel (BA), and LL were significantly greater in refracture group. Binary logistic regression analysis revealed previous fracture, cement leakage, post-LL, and correction of BA were independent risk factors. According to the ROC curve, correction of BA showed the highest prediction accuracy, and the critical value was 3.45°.

Conclusions

The occurrence of subsequent fracture might be the consequence of multiple factors. Previous fracture, cement leakage, post-LL, and correction of BA were identified as independent risk factors. Furthermore, the correction of BA should not exceed 3.45°, especially in patients with risk factors.

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Data availability

Data available from the corresponding author on reasonable request.

Abbreviations

OVCF:

Osteoporotic vertebral compression fracture

PVP:

Percutaneous vertebroplasty

PKP:

Percutaneous kyphoplasty

IVC:

Intravertebral cleft

BA:

Body angle

CA:

Cobb’s angle

SS:

Sacral slope

LL:

Lumbar lordosis

PS:

Psoas

ES:

Erector spinae

MF:

Multifidus

CSA:

Cross-sectional area

FI:

Fatty infiltration

ICC:

Intraclass correlation coefficient

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Authors and Affiliations

  1. Department of Orthopedics Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, China

    Zhi Chen, Zhipeng Yao, Chengjian Wu & Wenge Liu

  2. Department of Orthopedics Surgery, Fuqing Affiliated Hospital of Fujian Medical University, Fuzhou, 350001, Fujian, China

    Guohua Wang

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  1. Zhi Chen
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Correspondence to Wenge Liu.

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This study was conducted in accordance with the ethical standards and approved by our Institutional Review Board, as it was a retrospective study using anonymized data, so the requirement for informed consent and formal ethics approval was waived. All methods were performed in accordance with the relevant guidelines and regulations.

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The authors declare no competing interests.

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Chen, Z., Yao, Z., Wu, C. et al. Assessment of clinical, imaging, surgical risk factors for subsequent fracture following vertebral augmentation in osteoporotic patients. Skeletal Radiol 51, 1623–1630 (2022). https://doi.org/10.1007/s00256-022-04009-5

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