Percutaneous vertebral augmentation (PVA) represents a mainstream minimally invasive surgical procedure for the treatment of osteoporotic vertebral compression fractures (OVCF). However, postoperative complications often arise from bone cement leakage (CL). This study aimed to conduct a comprehensive meta-analysis to identify risk factors for CL and established a risk appraisal model based on the findings. We systematically reviewed seven major databases up to September 2024 to identify studies examining CL following PVA treatment in OVCF. Meta-analysis was performed using RevMan 5.4 software. The results were used to establish a risk appraisal model for CL. The meta-analysis identified several factors, including Cobb angle, Bone mineral density, Cement viscosity, Cement volume injected, Stage of bone cement injection, Cortical defect, Fracture severity, Intravertebral vacuum cleft, Basivertebral foramen sign and Number of vertebral fractures. The risk appraisal model constructed type Logit(P) = - 0.621 + 0.412X Cobb angle + 0.842X BMD + 0.842X Cement viscosity + 0.495X Cement volume injected + 0.432X Stage of bone cement injection + 0.775X Cortical defect + 0.438X Fracture severity + 0.358X IVC + 1.015X Basivertebral foramen sign + 0.742X Number of vertebral fractures. The receiver operating characteristic curve (ROC) curve showed an area under curve (AUC) of 0.831, and the Hosmer-Lemeshow test showed χ2 = 5.933, which is a good predictor of CL. The risk appraisal model was validated to have a moderately effective predictive value and can serve as a valuable tool for clinicians to assess leakage risk and improve patient management strategies during surgical interventions.

Neoplastic vertebral compression fractures are a debilitating complication of cancer, causing pain, limiting function, and reducing quality of life. Image-guided percutaneous vertebral augmentation (PVA) involves the injection of bone cement with or without a device into the vertebra. This offers effective stabilization and pain relief but has limitations. The standard polymethylmethacrylate cement is stiffer than native bone and lacks the ability to promote bone regeneration, raising concerns about poor biointegration and increased risk of future fractures. Moreover, exothermic polymerization can only destroy tumor cells within a limited area. Novel materials, such as polysiloxane, ceramics, and composites, offer improved bone integration and release of antineoplastic drugs. Additionally, various strategies that can be combined with PVA, such as radiation therapy, ablation techniques, interventional tumor removal, and minimally invasive screw fixation, could not only address the underlying neoplasm but also provide additional vertebral stabilization and reduce complications. While these advances hold promise, further research is needed to establish their safety and efficacy compared with the standard approach. Future endeavors should prioritize improving the mechanical properties of alternative materials to standard bone cement and facilitating large, long-term randomized controlled trials to validate the clinical outcomes of combined approaches and optimize treatment selection.

Advancements in Vertebral Augmentation: Innovations in Biomaterials and Cement Compositions.

To evaluate the short-and medium-term efficacy of posterior medial branch block in the treatment of persistent pain after percutaneous vertebral augmentation. From January 2018 to January 2023, a total of 1, 062 patients with osteoporotic vertebral compression fractures underwent percutaneous vertebral augmentation. Among them, 32 elderly patients who experienced persistent low back pain after surgery and subsequently received posterior medial branch block and cryoablation were included. Six patients died during follow-up, leaving 26 patients for final analysis (1 male, 25 females). The mean age was (82.96±5.66) years (ranged, 76 to 94 years). The mean body mass index was (23.76±3.08) kg·m-2(ranged 18.1 to 27.2 kg·m-2). The bone mineral density T-value ranged from -2.5 to -4.3 with a mean of (-3.09±0.56). The mean volume of bone cement injected was 6.00 (5.38, 7.00) ml. Fracture locations were T11 (2 cases), T12 (7 cases), L1 (10 cases), L2 (6 cases), and L3 (1 case). The mean interval from vertebral augmentation to block treatment was (7.12±2.22) months (rangd 6 to 12 months). The vertebral augmentation procedures were percutaneous kyphoplasty(PKP) in 12 cases and percutaneous vertebroplasty (PVP) in 14 cases. At the 2nd week, 3rd month, and 6th month after the block, the numerical rating scale(NRS), Oswestry disability index(ODI), patient satisfaction, and pain relief rate at the 6th month were evaluated. Relationships between pain relief rate at the 6th month after the last treatment and possible influencing factors were analyzed. Compared with X-ray films after percutaneous vertebral augmentation, the X-ray films before block showed an increase in kyphotic angle and vertebral compression rate, with statistically significant differences(P<0.05). At the 2nd week, 3rd month, and 6th month after posterior medial branch block and cryoablation, NRS and ODI scores were significantly lower than before the block(P<0.05). Among the 26 patients, 5 received additional cryoablation. At the 6th month after the last treatment, 19 patients reported excellent or good satisfaction. Univariate binary Logistic analysis showed all P>0.05, and no independent factor affecting final satisfaction or pain relief at 6 months after the last treatment was identified. Posterior medial branch block(with cryoablation) can effectively improve short-and medium-term symptoms and function in patients with persistent axial low back pain after percutaneous vertebral augmentation for osteoporotic vertebral fractures.

To identify the risk factors for subsequent vertebral fractures after percutaneous vertebral augmentation through the meta-analysis. Articles from 2019 to 2024 were retrieved from PubMed, Cochrane Library, Embase, and Web of Science. The quality of included studies was assessed using the Newcastle-Ottawa Scale (NOS), while data analysis was performed with R (The R Project for Statistical Computing). Fourteen articles comprising data from 5,673 patients were included in the analysis. Statistically significant differences were identified for age, gender, T-score (measured by dual-energy X-ray absorptiometry), body mass index (BMI), Computed tomography Hounsfield unit (CT HU) value, intravertebral cleft (IVC), multi-segment vertebral fractures, and bone cement leakage. In contrast, no statistically significant differences were observed for hypertension history, diabetes history, thoracolumbar vertebral fracture, postoperative Cobb angle, surgical method（percutaneous vertebroplasty/percutaneous kyphoplasty）, puncture method (unilateral/bilateral puncture), or bone cement volume. In Asian populations, advanced age, female, low T-score, low BMI, low CT HU values, presence of IVC, multi-segment vertebral fractures, and bone cement leakage are identified as significant risk factors for subsequent vertebral fractures following PVA. Conversely, a history of anti-osteoporosis treatment is identified as a protective factor, whereas hypertension history, diabetes history, thoracolumbar vertebral fracture, postoperative Cobb angle, surgical method, puncture method, and bone cement volume demonstrate no significant correlation with subsequent vertebral fractures after PVA.

The incidence and predictors of residual back pain (RBP) following percutaneous vertebral augmentation (PVA) in osteoporotic vertebral compression fractures (OVCFs) remain unclear. This review aims to clarify these factors to guide clinical practice and enhance patient outcomes. Four English and three Chinese databases were systematically searched from their inception until June 1, 2024. Data were analyzed using Stata 16.0. Incidence rates of RBP were pooled from all included studies, and predictors identified in two or more studies were aggregated. Sensitivity analyses were conducted for stability and reliability. Meta-regression and subgroup analyses were conducted to explore the causes of heterogeneity, while Begg, Egger test, and funnel plots were used to assess publication bias.This meta-analysis included 27 studies with a total of 8,806 patients, found that the incidence rate of RBP in patients with OVCFs after PVA was 24.4% (95% CI: 19.5-29.3%). Seventeen predictors for RBP were identified, which included demographic and personal history factors, injury characteristics, and bone cement and postoperative factors. The most frequent predictor was low preoperative bone density (OR = 2.208, 95% CI: 2.018-2.415, p < 0.001), followed by thoracolumbar fascia injury (OR = 3.875, 95% CI: 2.752-5.457, p < 0.001) and maldistribution of bone cement (OR = 2.065, 95% CI: 1.728-2.467, p < 0.001). Fifteen risk factors and two protective factors for RBP were identified. These findings highlight the importance of thorough preoperative assessment and meticulous surgical technique in reducing the risk of RBP in patients with OVCFs undergoing PVA.This study conducted a systematic review and meta-analysis to explore the incidence and predictors of residual back pain (RBP) in patients with osteoporotic vertebral compression fractures (OVCFs) who had underwent percutaneous vertebral augmentation (PVA).The findings identified a total of fifteen risk factors and two protective factors associated with RBP. Specifically, low preoperative bone density, thoracolumbar fascia injury, and maldistribution of bone cement were revealed to be the most common predictors.

Osteoporotic vertebral compression fractures (OVCFs) are common in older persons, and percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) are effective minimally invasive treatments. This systematic review and meta-analysis aim to update knowledge on risk factors associated with NVCF after these procedures. PubMed, EMBASE, and the Cochrane Library were searched to December 2023 for studies evaluating risk factors for NVCF after PVP and PKP, using the following keywords: "osteoporotic vertebral compression fractures," "percutaneous vertebral augmentation," "vertebroplasty", "kyphoplasty," "new vertebral fracture," and "risk factor". Eligible studies included randomized controlled trials (RCTs), prospective and retrospective studies, and case-control studies. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to derive summary effects. Heterogeneity among the studies was assessed using the I2 statistic. Fifteen studies including a total of 6,546 patients were analyzed. Significant risk factors for new vertebral fractures (NVCF) following PVP and PKP were older age (adjusted OR [aOR] = 1.08, 95% CI: 1.01-1.15), female sex (aOR = 2.11, 95% CI: 1.60-2.79), a higher number of treated vertebrae (aOR = 2.27, 95% CI: 1.18-4.35), and cement leakage (aOR = 3.43, 95% CI: 2.17-5.41). No statistical significances on the associations between bone mineral density (BMD), body mass index (BMI) with NVCF were observed. Significant risk factors for NVCF after PVP and PKP include older age, female sex, higher number of treated vertebrae, and cement leakage. The findings highlight the importance of careful patient selection to minimize the risk of NVCF. IV.

CO136 Racial and Health Insurance Status Disparities in the Use of Percutaneous Vertebral Augmentation and Healthcare Utilization for Osteoporotic Vertebral Fractures: A Retrospective Observational Analysis

Osteoporotic vertebral compression fractures (OVCFs) are a major public health concern. While percutaneous vertebral augmentation (PVA) is an effective treatment for OVCF, adjacent vertebral fractures (AVF) often occur post-PVA, adversely affecting treatment outcomes. This study aims to develop a nomogram for predicting AVF risk using multicenter data to aid clinical decision-making for OVCF patients. We retrospectively analyzed patients who underwent PVA at 3 hospitals between 2017 and 2022. The cohort was divided into a training set (80%) and a validation set (20%). Independent risk factors for AVF were identified using LASSO (least absolute shrinkage and selection operator) and logistic regression. Seven significant factors were: bone mineral density, diabetes, total fractured vertebrae, intravertebral vacuum cleft sign, recovery of local kyphosis angle, regular aerobic exercise, and lumbar brace use. Among the 483 patients, 52 (10.76%) developed adjacent vertebral refractures within 2 years. The nomogram demonstrated high predictive accuracy, with area under the curves of 89.21% in the training set and 98.33% in the validation set. This pioneering nomogram, incorporating baseline, surgical, and postoperative factors, provides valuable guidance for spine surgeons in preoperative planning and postoperative management, enabling personalized prognosis and rehabilitation for OVCF patients.

Kidney Nourishing and Bone Strengthening Decoction, a traditional Chinese herbal formula, has been known for its role in regulating bone metabolism and enhancing bone density (BD). Osteoporotic compression fractures are common clinical complications in patients with osteoporosis, and percutaneous vertebral augmentation is a commonlyused treatment method. This work aimed to investigate the preventive effect of the Kidney Nourishing and Bone Strengthening Decoction combined with conventional Western medicine treatment on the occurrence of vertebral re-fracture after percutaneous vertebral augmentation in osteoporotic compression fractures. Kidney Nourishing and Bone Strengthening Decoction combined with conventional Western medicine treatment was an integrated therapeutic approach that can effectively prevent vertebral re-fracture after percutaneous vertebral augmentation in osteoporotic compression fractures, regulate bone metabolism, and enhance BD.

This work aimed to investigate the risk factors for fractures in sandwich vertebrae (SDV; an unfractured vertebra located between 2 cemented vertebrae) formed after percutaneous vertebral augmentation (PVA) and to construct a predictive model from this. This study retrospectively analyzed patients who underwent PVA with the formation of SDV from July 2018 to July 2023 at Affiliated Banan Hospital of Chongqing Medical University. Patients were divided into a fracture group and a control group according to the presence or absence of fracture of the SDV during the 1-year postoperative follow-up period. Independent predictors were confirmed using the least absolute shrinkage and selection operator (LASSO) method, and the nomogram was constructed and transformed into an online calculator. The discrimination, calibration, and clinical applicability of the model were assessed by Area under the receiver operating characteristic curve (AUC), calibration curve analysis, and Decision curve analysis (DCA). Finally, the model was externally validated using data from another centre and internally validated using Bootstrap. A total of 259 patients were enrolled in this study, and 36 patients had fractures of SDV within one year. Multifactorial analyses showed that low bone mineral density (BMD) (OR = 4.264, 95% CI: 2.245-8.098, P < 0.001), number of PVA > 3 (OR = 3.703, 95% CI: 1.399-9.801, P = 0.008), lack of anti-osteoporosis (OR = 4.051, 95% CI: 1.573-10.430, P = 0.004), postoperative kyphosis angle of sandwich fracture segments (PKASFS) > 10° (OR = 8.273, 95% CI: 2.991-22.881, P < 0.001), and lumbar lordosis minus thoracic kyphosis (LL-TK) < 0° (OR = 3.701, 95% CI: 1.523-8.994, P = 0.004) were screened as independent risk factors. The AUC of the model constructed based on this was 0.881 (95% CI: 0.829-0.933). The calibration curves and DCA verified that the model had satisfactory practical consistency and clinical applicability. The externally validated AUC was 0.859 (95% CI: 0.788-0.930), validating the stability of the model. BMD, number of PVA, anti-osteoporosis, PKASFS, and LL-TK are independent influencing factors for fractures in SDV within one year, and a model based on this had excellent predictive efficacy.

Sagittal spinal malalignment is associated with functional disability. Therefore, a key question in treating patients with painful osteoporotic vertebral compression fractures (OVCFs) is whether vertebral augmentation improves sagittal alignment and its associated outcomes. In a systematic literature review based on interventional and observational studies, we evaluated the effect of percutaneous vertebral body augmentation on sagittal alignment and pulmonary function in patients with painful OVCFs. In November 2022 and December 2023, we searched for relevant studies in Medline, Embase, SCOPUS, Web of Science, the Cochrane Central Registry of Controlled Trials, and five trial registries. In total, 15 cohort studies and two non-randomized clinical trials met our inclusion criteria. Participants in these studies had painful OVCFs treated with vertebral body augmentation. Sagittal alignment outcomes from nine articles represented 456 participants with mean ages from 69.3 to 80.8 years, and pulmonary function outcomes from eight articles represented 343 participants with mean ages from 69.1 to 75.7 years. The quality assessment tool for quantitative studies by the Effective Public Health Practice Project assessed the risk of bias (RoB). Mean pre- and postoperative outcome values were calculated for all included studies and those without a high RoB. None of the sagittal alignment parameters improved after vertebral augmentation, and no additional deformity was detected. Vertebral augmentation positively affected pulmonary function, as measured by the percentage of predicted values, and reduced perceived pain levels and functional disability. Data in the included studies were incomplete due to variability in chosen outcomes and follow-up time points. The incomplete data curtailed our data analysis and only allowed cautious conclusions. Variations in study populations and protocols highlight the need for standardized reporting and follow-up in future research.

Purpose To evaluate the safety and efficacy of vertebral augmentation (VA) and radiofrequency ablation (RFA) for treating pathologic spinal fractures in patients with cancer and adjacent fracture risk following treatment. Materials and Methods This single-institution retrospective study, conducted from January 2017 to September 2020, included patients with cancer who underwent percutaneous VA with or without spine RFA for pathologic spine compression fractures. The primary outcome was pain reduction, assessed using the 10-point visual analog scale before the procedure, at first follow-up, and 2-4 weeks after the procedure. Logistic regression was performed to identify factors associated with epidural cement leak. Results A total of 638 spinal levels in 335 patients (median age, 65 years [IQR, 58-74 years]; 147 female, 188 male) were treated. Epidural tumor and retropulsion of bone fragments were present in 15% (93 of 638) and 13% (81 of 638) of treated levels, respectively, while posterior wall erosion was observed in 30% (190 of 638). Substantial pain improvement (greater than two-point reduction) occurred in 81% (519 of 638) of cases. Factors associated with decreased risk of epidural cement leak included RFA (42% no leak vs 38% leak, P = .03) and lumbar treatments (49% no leak vs 38% leak, P = .02). Adjacent-level fractures occurred in 10.4% of patients. The total complication rate (National Cancer Institute Common Terminology Criteria for Adverse Events grade 3 or higher) was 0.6% (four of 638). Conclusion VA and RFA are safe and efficacious treatments for spine fractures in patients with cancer. Keywords: Ablation Techniques, Kyphoplasty, Vertebroplasty © RSNA, 2025.

BackgroundPercutaneous vertebral augmentation (PVA) via the unilateral transverse process-pedicle approach (UTPPA) has shown promise for treating painful osteoporotic vertebral compression fractures (OVCFs). This study aimed to investigate the anatomical parameters of PVA for thoracic spine via the UTPPA using a three-dimensional computed tomography (3D CT) database.MethodsPVA was simulated through the UTPPA on 3D CT scans on 100 patients (50 men and 50 women), involving a total of 1200 thoracic vertebral bodies (T1-T12). Anatomical parameters, including the distance between the bone entry puncture point and the midline of the vertebral body (DEM), the puncture inner inclination angle (PIA), the maximum PIA (Amax), the middle PIA (Amid), the minimum PIA (Amin), the safe range of the PIA (SRA), and the minimum transverse pedicle width (MTPW), were measured and compared.ResultsThe mean DEM ranged from 17.60 ± 2.63 mm to 22.71 ± 4.07 mm, and the Amid ranged from 24.27° ± 2.21° to 40.77° ± 6.11°. The mean left DEM was significantly larger than the right (p < 0.001). The right SRA was significantly larger than the left (p < 0.001). The mean DEM, SRA and MTPW were significantly larger in men than in women (p < 0.001).ConclusionIn PVA for thoracic spine treatment using UTPPA, our study demonstrated that selecting this approach in men and puncturing from the right side in the thoracic vertebrae could be safer.

Background: Percutaneous vertebral augmentation techniques, including vertebroplasty, kyphoplasty, and bone tumor radiofrequency ablation (BT-RFA), are commonly used to treat painful vertebral compression fractures (VCFs). While generally safe and effective, they carry risks, including cement extravasation, which can lead to pulmonary embolism or spinal cord compression. This study aims to compare the rate of cement extravasation across different vertebral augmentation techniques and identify potential risk factors. Methods: A retrospective cohort study was conducted at a comprehensive cancer center on 1002 procedure encounters in 888 patients who underwent vertebral augmentation for painful VCFs. Data were collected on patient demographics, fracture pathology, procedure type, imaging guidance, and pain scores. Intraoperative and postoperative imaging were manually reviewed to assess cement extravasation. Statistical analyses were performed using pairwise comparisons with Tukey's Honest Significant Difference adjustment to compare cement extravasation rates across the procedure groups and generalized linear mixed models to assess the association between the cement extravasation with other variables. Results: Cement extravasation occurred in 573 (57.2%) encounters. Kyphoplasty had the lowest rate of cement extravasation (46.2%) with significantly lower odds compared to vertebroplasty (OR: 0.42, 95% CI: 0.30-0.58; p < 0.0001) and BT-RFA (OR: 0.57, 95% CI: 0.42-0.77; p = 0.0009). Pathologic fractures and multilevel augmentations were linked to a 64% (p = 0.001) and 63% (p = 0.0003) increased odds of cement extravasation, respectively. Male sex and older age were protective factors. Conclusions: Cement extravasation is a common but largely asymptomatic complication of percutaneous vertebral augmentation. It is crucial to consider patient-specific risk factors when selecting an augmentation technique to optimize outcomes. Kyphoplasty may be the optimal choice for patients at increased risk of cement extravasation.

To evaluate the association between a thoracolumbar fascia injury (TLFI) and the development of residual back pain (RBP) following percutaneous vertebral augmentation (PVA). Osteoporotic vertebral compression fractures (OVCF) commonly affect elderly individuals and those with osteoporosis, leading to pain and limited mobility. Percutaneous vertebral augmentation provides immediate pain relief and stabilization of the fractures. However, some patients experience residual pain after the treatment. Although recent studies have suggested a potential association, the role of TLFI in RBP remains inconclusive. The aim of this meta-analysis was to evaluate this association. A thorough search was performed across the PubMed, Medline, Embase, Web of Science, and Cochrane Library databases from inception to 31 December 2024 to identify studies examining the link between TLFI and RBP following PVA. A random-effects model was used to combine the outcome data to account for the potential heterogeneity among the included studies. This meta-analysis included 13 studies with a total of 4,542 participants and a TLFI incidence rate of 28%. Univariate analysis indicated that patients with a TLFI were significantly more likely to develop RBP compared to those without a TLFI, with an odds ratio (OR) of 4.19 (95% CI: 2.49 to 7.05, I² = 76.9%). The sensitivity analysis identified two studies as significant influential outliers that contributed to the majority of the observed heterogeneity. Excluding these studies resulted in an OR of 4.62 (95% CI: 3.61 to 5.92, I² = 0%). The multivariate analysis confirmed a strong association between TLFI and RBP after adjusting for confounders and other risk factors, with an OR of 4.57 (95% CI: 3.28 to 6.37, I² = 81.5%). The sensitivity analysis identified three studies as significant influential outliers, and excluding them resulted in an OR of 4.79 (95% CI: 3.76 to 6.11, I² = 0%) with no heterogeneity. This finding further confirms the association with a more homogenous overall effect estimate. The pooled effect size of both univariate and multivariate analyses consistently demonstrated that a TLFI significantly increased the risk of developing RBP after PVA regardless of other related risk factors. Recognizing fascia injury as a potential source of postoperative pain in clinical practice could enhance the care of these patients and mitigate postoperative pain.

Study DesignRetrospective cohort study.ObjectivesTo investigate the incidence of neurological deficits associated with percutaneous vertebral augmentation (PVA) surgery and to identify related risk factors.MethodsWe performed a retrospective analysis of the clinical data of patients who underwent PVA surgery at our institution between 2017 and 2022. A range of clinical parameters, including age, sex, fracture cause, fracture segment, number of vertebrae treated, surgical approach and surgical method, were collected.ResultsThis study included a total of 1847 patients, including 422 (22.8%) men and 1425 (77.2%) women, with a total of 2319 diseased vertebrae. The mean age of the patients was 70.71 ± 8.80 years, with 211 (11.4%) patients aged under 60 years and 1636 (88.6%) patients aged over 60 years. Forty-six (2.5%) patients, accounting for 67 diseased vertebrae, were treated for tumors, whereas the remaining 1801 (97.5%) patients underwent surgery for fractures. Four hundred seventy-eight (20.6%) vertebrae underwent unilateral puncture, and the remaining 1841 (79.4%) vertebrae underwent bilateral puncture. Percutaneous vertebroplasty was performed on 1781 (76.8%) vertebrae, whereas percutaneous kyphoplasty was chosen for the remaining 538 (23.2%) vertebrae. Postoperative X-ray evaluations were conducted on the treated vertebrae, revealing that 403 (17.4%) vertebrae experienced polymethylmethacrylate (PMMA) leakage. Among the 1847 patients, 6 (7 diseased vertebrae) experienced nerve injuries postoperatively, and the incidence of neurological deficits after PVA surgery was 0.32%. Four of the 6 patients had nerve injuries due to PMMA leakage, and the other 2 patients had failed punctures. There was no statistically significant difference in terms of neurological complication rates according to patient age, sex, fracture segment, number of vertebrae treated, surgical approach or surgical method. However, the incidence of neurological complications was greater for patients with neoplastic fractures who underwent PVA surgery than for those with osteoporotic fractures.ConclusionsPVA is an effective minimally invasive procedure for treating osteoporotic and neoplastic vertebral fractures. However, PVA can lead to serious neurological deficits. The incidence of neurological deficits associated with PVA surgery is 0.32%. Compared with patients with osteoporotic fractures, patients with neoplastic vertebral fractures who undergo PVA have a greater risk of neurological complications.

CORR Insights®: What Risk Factors Are Associated With Recurrent Osteoporotic Vertebral Compression Fractures After Percutaneous Vertebral Augmentation? A Meta-analysis.

BackgroundVertebral height loss of fractured vertebrae treated by percutaneous vertebral augmentation (PVA) for osteoporotic vertebral compression fracture (OVCFs) during follow-up had been reported. Mostly, vertebral height loss and its relevant terms (e.g., “recompression”, “recollapse” and “refracture”) were defined according to immediate postoperative vertebral height as the baseline in published studies. By contrast, vertebral height deterioration (VHD) was defined according to preoperative vertebral height as the baseline in the present study. The aim of the study was to reveal predictors for VHD in fractured vertebrae operated by percutaneous vertebroplasty (PVP), with a specific focus on surgical factors.MethodsAll patients with OVCFs treated by PVP between April 2016 and September 2018 were retrospectively reviewed. Patients were followed up for at least 12 months after procedure according to treatment protocol. VHD was defined as the presence of a decrease of vertebral height at final follow-up compared to preoperative. Clinical, radiological and surgical factors that might affect occurrence of VHD were assessed using univariate and multivariate analyses.ResultsA total of 543 patients (females 80%, age 73.2 ± 8.1 years) with 681 fractured vertebrae who underwent PVP were enrolled. Mean follow-up time was 28.9 ± 13.4 months (range, 12–59 months). Incidence of VHD in fractured vertebrae was 48.9% (333/681). One clinical factor and four radiological factors, including fracture age (OR = 0.513, 95% CI 0.385–0.683, p = 0.000), fracture location (OR = 2.878, 95% CI 1.994–4.152, p = 0.000), fracture severity (OR = 0.521, 95% CI 0.386–0.703, p = 0.000), cortical defect on lateral wall (OR = 2.535, 95% CI 1.351–4.758, p = 0.004) and intravertebral cleft (OR = 2.362, 95% CI 1.488–3.750, p = 0.000), were independent predictors for VHD. However, all the surgical factors evaluated were not significant in final model analysis.ConclusionsSurgical factors might play a negligible effect on VHD. VHD might be due to natural course of fracture/osteoporosis.

BackgroundVertebral Hounsfield unit (HU) were regarded as a new way to predict fragility fracture. However, HU values were measured in a single plane, which is not accurate for the entire vertebral body. This study aimed to create a new CT-based metric for assessing bone mineral density, three-dimensional Hounsfield unit value (3D-HU), and to evaluate its effect in independently predicting new vertebral fracture (NVF) after percutaneous vertebral augmentation (PVA) in postmenopausal women.MethodsThis study reviewed female patients with osteoporotic vertebral compression fracture (OVCF) who were treated at our hospital. Patients were divided into NVF and control groups according to whether they had NVF. 3D-HU of the L1-4 vertebrae was measured using preoperative computed tomography (CT) scanning of the lumbar spine. Demographics, procedure-related data, and radiological data were collected. Pearson correlation test was used to determine the correlation between 3D-HU and BMD T-score. The independent risk factors of NVF were determined by multivariate logistic regression analyses. Receiver operating characteristic curve (ROC) was used to evaluate the predictive performance of 3D-HU.ResultsThis study involved 349 postmenopausal women who were treated with PVA between January 2017 and August 2022. Among them, 61 people suffered the NVF following PVA. The mean 3D-HU was 40.64 ± 22.43 in the NVF group and 79.93 ± 25.69 in the without NVF group (p < 0.001). Multivariate analysis showed that lower 3D-HU (OR = 0.927; 95%CI = 0.906–0.945; p < 0.001) was the only independent predictor of NVF following PVA. The predictive accuracy of 3D-HU was 87.7%, which was higher than that of the HU value (82.3%), and it was highly positively correlated with BMD T-score (r = 0.628, p < 0.001).ConclusionsLower 3D-HU was significantly associated with NVF following PVA in postmenopausal women. In addition, vertebral 3D-HU had better predictive power than HU values. 3D-HU assessment prior to PVA may provide insight into a patient’ s risk for NVF.