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Risk factor analysis for re-collapse of cemented vertebrae after percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP)

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Abstract

Purpose

Re-collapse of cemented vertebrae occasionally occurs after percutaneous augmentation. However, the potential risks still remain unclear. Several articles have reported some possible risk factors which were not consistent or comprehensive. This study aimed to make a retrospective review on patients with osteoporotic vertebral compression fracture (OVCF) after percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) and to further analyse the risk factors for treated vertebral refracture.

Methods

All patients receiving the PKP/PVP with bilateral approach were retrospectively reviewed from January 2014 to January 2016, among whom 230 patients with single level augmentation (30 in refracture group and 200 in the non-refracture group) were enrolled according to inclusion criteria. The following covariates were reviewed: gender, age, height, weight, body mass index (BMI), bone mineral density (BMD), serum bone turnover markers, surgical parameters including approach, cement volume, anterior height, and Cobb angle restoration. Binary logistic regression analysis was used to determine the relative risk of re-collapse of cemented vertebrae.

Results

Regarding the patient data, weight, BMI, and BMD were of statistical significance in refracture group (P < 0.01), among which only low BMD was a risk factor to cemented vertebral re-collapse (P = 0.022, OR = 4.197). In respect of surgical variables, the better restoration of anterior height and Cobb angle was found in refracture group (P < 0.05), both of which might increase the refracture risk but not be risk factors (P = 0.065, OR = 0.891, and P = 0.937, OR = 0.996, respectively). Besides, less injected cement (3.30 ± 0.84 ml vs 4.46 ± 1.10 ml, P = 0.000, OR = 19.433) and PKP (P = 0.007, OR = 13.332) significantly boosted the potential risk of refracture (P < 0.001).

Conclusion

Patients with low BMD, or undergoing PKP, or receiving a low volume of injected cement might have a high risk of re-collapse in surgical vertebrae.

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Funding

This work was supported by grants from the Guangdong Natural Science Foundation (2016A030313641), Guangdong Science and Technology Project (2016A020215137), Guangzhou Science and Technology Project (201707010460), Open Foundation of National Key Laboratory of Orthopedics of Traditional Chinese Medicine (YB12), and National College Students’ Innovation and Entrepreneurship Training Program (201610572262).

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Author notes

  1. Yong-xian Li and Dan-qing Guo contributed equally to this work.

Authors and Affiliations

  1. The First Clinical Academy, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China

    Yong-xian Li, Guo-ye Mo, Da-xing Li, Hui-zhi Guo & Pei-jie Luo

  2. The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China

    Yong-xian Li, Dan-qing Guo, Shun-cong Zhang, De Liang, Kai Yuan, Guo-ye Mo, Da-xing Li, Hui-zhi Guo & Yongchao Tang

  3. Laboratory Affiliated to National Key Discipline of Orthopedic and Traumatology of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China

    Yong-xian Li, Dan-qing Guo, Shun-cong Zhang, De Liang, Kai Yuan, Guo-ye Mo, Da-xing Li, Hui-zhi Guo, Yongchao Tang & Pei-jie Luo

  4. First School of Clinical Medicine, Guangzhou University of Chinese Medicine, 12 Airport Road, Baiyun District, Guangzhou, 510405, Guangdong, People’s Republic of China

    Shun-cong Zhang & De Liang

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  1. Yong-xian Li
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Correspondence to Shun-cong Zhang or De Liang.

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Li, Yx., Guo, Dq., Zhang, Sc. et al. Risk factor analysis for re-collapse of cemented vertebrae after percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP). International Orthopaedics (SICOT) 42, 2131–2139 (2018). https://doi.org/10.1007/s00264-018-3838-6

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  • DOI: https://doi.org/10.1007/s00264-018-3838-6

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