Department of Orthopaedics, Sichuan University West China Hospital, Chengdu, Sichuan, China.
Department of Orthopaedics, Chengdu First People's Hospital, Chengdu, Sichuan, China.
J Neurointerv Surg. 2021 Nov;13(11):1058-1062. doi: 10.1136/neurintsurg-2020-016985. Epub 2021 Jan 19.
It is unclear whether the sandwich vertebra, is at higher risk of new symptomatic fractures (NSFs), and whether prophylactic augmentation might benefit patients with sandwich vertebrae.
To compare fracture-free probabilities of sandwich, ordinary-adjacent, and non-adjacent vertebrae, and identify predictors of NSFs.
Data were retrospectively analyzed for patients who had undergone vertebral augmentation resulting in sandwich vertebrae. NSF rates were determined and predictors were identified using Cox proportional hazard models.
The analysis included 1408 untreated vertebrae (147 sandwich, 307 ordinary-adjacent, 954 non-adjacent vertebrae) in 125 patients. NSFs involved 19 sandwich, 19 ordinary-adjacent, and 16 non-adjacent vertebrae. The NSF rate was significantly higher in the patients with sandwich vertebrae (27.2%) than among all patients (14.8%). At the vertebra-specific level, the NSFs rate was 12.9% for sandwich vertebrae, significantly higher than 6.2% for ordinary-adjacent and 1.7% for non-adjacent vertebrae. The corresponding fracture-free probabilities of sandwich, ordinary-adjacent, and non-adjacent vertebrae were 0.89, 0.95, and 0.99 at 1 year, and 0.85, 0.92, and 0.98 at 5 years (p<0.05). Cox modeling identified the following as predictors for occurrence of an NSF in a given vertebra: vertebra location, type of vertebrae, number of augmented vertebrae, and puncture method.
Sandwich vertebrae are at higher risk of NSFs than ordinary-adjacent and non-adjacent vertebrae, and several NSF risk factors were identified. Since 85% of sandwich vertebrae are fracture-free for 5 years and NSF risk increases with the number of augmented vertebrae, prophylactic augmentation of every sandwich vertebra may be unnecessary.
目前尚不清楚夹心椎发生新发症状性骨折（NSF）的风险是否更高，预防性增强是否对夹心椎患者有益。
比较夹心椎、普通相邻椎和非相邻椎的无骨折概率，并确定 NSF 的预测因素。
对接受过椎体增强导致夹心椎的患者进行回顾性数据分析。确定 NSF 发生率，并使用 Cox 比例风险模型识别预测因素。
该分析包括 125 名患者的 1408 个未治疗椎骨（147 个夹心椎、307 个普通相邻椎、954 个非相邻椎）。NSF 涉及 19 个夹心椎、19 个普通相邻椎和 16 个非相邻椎。夹心椎患者的 NSF 发生率（27.2%）明显高于所有患者（14.8%）。在椎骨特异性水平，夹心椎的 NSF 发生率为 12.9%，明显高于普通相邻椎的 6.2%和非相邻椎的 1.7%。夹心、普通相邻和非相邻椎的相应无骨折概率分别为 1 年时为 0.89、0.95 和 0.99，5 年时为 0.85、0.92 和 0.98（p<0.05）。Cox 模型确定了以下因素是给定椎骨发生 NSF 的预测因素：椎骨位置、椎骨类型、增强椎骨数量和穿刺方法。
夹心椎发生 NSF 的风险高于普通相邻椎和非相邻椎，确定了几个 NSF 风险因素。由于 85%的夹心椎在 5 年内无骨折，且 NSF 风险随增强椎骨数量增加而增加，因此可能无需对每个夹心椎进行预防性增强。
