Abstract
BackgroundDue to its unique mechanical characteristics, the incidence of subsequent fracture after vertebral augmentation is higher in thoracolumbar segment, but the causes have not been fully elucidated. This study aimed to comprehensively explore the potential risk factors for subsequent fracture in this region.MethodsPatients with osteoporotic vertebral fracture in thoracolumbar segment who received vertebral augmentation from January 2019 to December 2020 were retrospectively reviewed. Patients were divided into refracture group and non-refracture group according to the occurrence of refracture. The clinical information, imaging findings (cement distribution, spine sagittal parameters, degree of paraspinal muscle degeneration) and surgery related indicators of the included patients were collected and compared.ResultsA total of 109 patients were included, 13 patients in refracture group and 96 patients in non-refracture group. Univariate analysis revealed a significantly higher incidence of previous fracture, intravertebral cleft (IVC) and cement leakage, greater fatty infiltration of psoas (FIPS), fatty infiltration of erector spinae plus multifidus (FIES + MF), correction of body angle (BA), BA restoration rate and vertebral height restoration rate in refracture group. Further binary logistic regression analysis demonstrated previous fracture, IVC, FIPS and BA restoration rate were independent risk factors for subsequent fracture. According to ROC curve analysis, the prediction accuracy of BA restoration rate was the highest (area under the curve was 0.794), and the threshold value was 0.350.ConclusionsSubsequent fracture might cause by the interplay of multiple risk factors. The previous fracture, IVC, FIPS and BA restoration rate were identified as independent risk factors. When the BA restoration rate exceeded 0.350, refractures were more likely to occur.
Highlights
Due to its unique mechanical characteristics, the incidence of subsequent fracture after vertebral augmentation is higher in thoracolumbar segment, but the causes have not been fully elucidated
Demographic characteristics and imaging findings Based on the inclusion and exclusion criteria, a total of 109 patients were included in this study, the duration of follow-up was 17.53 ± 6.47 month
Univariate analysis revealed no significant differences in age, sex, number of fracture, surgical technique (PVP or percutaneous kyphoplasty (PKP)), cement distribution, vertebral compression rate, r-CSAPS, r-CSAES + MF, pre-body angle (BA), pre-Cobb’s angle (CA), pre-Thoracolumbar kyphosis (TLK), pre-Lumbar lordosis (LL) and postoperative body angle (post-BA)
Summary
Due to its unique mechanical characteristics, the incidence of subsequent fracture after vertebral augmentation is higher in thoracolumbar segment, but the causes have not been fully elucidated. This study aimed to comprehensively explore the potential risk factors for subsequent fracture in this region. Due to its unique anatomical location and mechanical characteristics, thoracolumbar segment has a higher incidence of subsequent fracture after vertebral augmentation, but the causes have not been fully elucidated. Whereas the exact association between paraspinal muscle degeneration with subsequent fracture after vertebral augmentation remained largely unknown. In this context, we conducted this study to comprehensively evaluate the potential risk factors for subsequent fracture in thoracolumbar segment, including the effect of paraspinal muscles
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