Analysis of Risk Factors for Subsequent Fractures Following Percutaneous Kyphoplasty for Single-Segment Osteoporotic Vertebral Compression Fractures

Abstract

Abstract Objective: The purpose of this study was to look into the risk factors for recurrent fractures following percutaneous kyphoplasty (PKP) in patients with single-level osteoporotic vertebral compression fractures (OVCF). Methods: This retrospective cohort study analyzed the clinical data of 289 patients who underwent PKP for single-segment OVCF at our institution from January 2018 to December 2020. The patients were categorized into the refracture group (39 cases) and the non-refracture group (250 cases) based on whether new vertebral fractures occurred postoperatively. Sex, age, body mass index (BMI), hypertension, diabetes, bone mineral density (BMD), osteoporosis treatment, fracture level, bone cement injection volume, bone cement leakage, bone cement distribution, spinal scoliosis, pre-and postoperative Cobb angles, and vertebral height restoration rate were recorded. Univariate analysis was conducted to examine the correlation between variables and subsequent vertebral fractures. Subsequently, multivariable logistic regression analysis was performed to determine independent risk factors.. Nonrestrictive cubic spline functions were employed to explore the correlations between the independent risk factors selected from the multivariate analysis. Results: The univariate analysis revealedthat age, BMI, BMD, postoperative anti-osteoporosis treatment, fracture level, preoperative Cobb angle, and vertebral height restoration rate were significantly correlated with postoperative vertebral refracture after PKP (P<0.05). The results of the multivariable logistic regression analysis revealed that a BMD less than -2.6 (odds ratio (OR)=0.64, 95% confidence interval (CI)0.45,0.90, P<0.05) and a vertebral height restoration rate greater than 9.8% (OR=1.40, 95% CI 1.17,1.68, P<0.01) were significantly linked to post-PKP recurrent fractures. The results of the nonrestrictive cubic spline function indicated a monotonic relationship between BMD and risk of PKP refracture. The risk of PKP refracture decreased with increased BMD after PKP surgery. The relationship between vertebral height restoration rate and the risk of PKP refracture followed a "U" shaped pattern. After the vertebral height restoration rate exceeded 9.8%, the risk of PKP refracture increased, reaching its highest point at 26.1% and then slightly declining. Conclusions: BMD<-2.6 and a vertebral height restoration rate>9.8% are independent risk factors for postoperative vertebral refracture in patients with OVCF following PKP.