Department of Orthopedic Surgery, Guri Hospital, Hanyang University College of Medicine, 153 Gyeongchun-ro, Guri-si, Gyeonggi-do 11923, South Korea; Department of Orthopedics, Samsung Medical Center, Sungkyunkwan University, School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea.
Department of Orthopedic Surgery, Guri Hospital, Hanyang University College of Medicine, 153 Gyeongchun-ro, Guri-si, Gyeonggi-do 11923, South Korea.
Spine J. 2021 Aug;21(8):1355-1361. doi: 10.1016/j.spinee.2021.04.022. Epub 2021 May 7.
BACKGROUND CONTEXT: Although risk factors of new adjacent vertebral fracture (AVF) and remote vertebral fracture (RVF) after vertebroplasty may differ, research on this topic is lacking. PURPOSE: To determine the natural course of new vertebral fractures after vertebroplasty for osteoporotic vertebral compression fracture (OVCF) and to analyze each risk factor for understanding the incidence of AVF and RVF. STUDY DESIGN: Retrospective cohort study. PATIENT SAMPLE: The study subjects included 205 patients who received vertebroplasty for OVCF and were followed-up for at least 1-year. OUTCOME MEASURES: Data on factors that could affect the occurrence of vertebral fractures, such as age, body mass index, and bone density, were collected from the patients' medical records. Fracture pattern, fracture location, sagittal imbalance, degree of segmental kyphosis after vertebroplasty, cement distribution, and cement leakage were radiologically examined. METHODS: xDuring the follow-up period, any newly developed vertebral fractures were identified. We analyzed whether the time of occurrence differed between AVF and RVF by performing a survival analysis and each risk factor separately. RESULTS: New vertebral fractures occurred in 47 patients (22.9%) after vertebroplasty, AVF occurred in 21 patients (10.2%), and RVF occurred in 26 patients (12.7%). The onset time of AVF was 6.2±1.8 months after vertebroplasty, showing a significant difference from that of RVF, which was 15.2±1.8 months (p<.001). In the univariate analysis, the risk factors of AVF included severe osteoporosis (T-score<-3.0), vertebroplasty in the thoracolumbar junction, sagittal imbalance, and segmental kyphosis angle >15° (p=0.029, p=0.033, p=0.001, and p=0.021, respectively). The risk factors of RVF included severe osteoporosis (T-score <-3.0) and sagittal imbalance (p=0.013 and p=0.004). In the multivariate analysis, the risk factors of AVF included vertebroplasty in the thoracolumbar junction and sagittal imbalance (hazard ratio=3.34, p=0.032 and hazard ratio=4.05, p=0.008), and those of RVF included only sagittal imbalance (hazard ratio=2.66, p=0.024). CONCLUSON: After vertebroplasty for OVCF, a significant difference in the meantime of occurrence was found; it took 6 months for AVF and 15 months for RVF to develop. Vertebroplasty in the thoracolumbar junction was identified as a risk factor for AVF, whereas sagittal imbalance was a risk factor of both AVF and RVF.
背景：椎体成形术后新发临近椎体骨折（AVF）和远处椎体骨折（RVF）的危险因素可能不同，但对此类问题的研究尚少。 目的：明确骨质疏松性椎体压缩性骨折（OVCF）椎体成形术后新发椎体骨折的自然病程，并分析各危险因素，以了解 AVF 和 RVF 的发生率。 研究设计：回顾性队列研究。 研究对象：本研究纳入了 205 例因 OVCF 接受椎体成形术治疗且随访时间至少 1 年的患者。 观察指标：从患者病历中收集可能影响骨折发生的因素数据，如年龄、体重指数和骨密度等。影像学检查骨折模式、骨折部位、矢状面失平衡、椎体成形术后节段后凸角、骨水泥分布和骨水泥渗漏情况。 方法：在随访期间，发现任何新发的椎体骨折。通过生存分析和单独分析每个危险因素，来分析 AVF 和 RVF 发生的时间是否存在差异。 结果：椎体成形术后，47 例患者（22.9%）发生新的椎体骨折，其中 21 例（10.2%）发生 AVF，26 例（12.7%）发生 RVF。AVF 的发病时间为椎体成形术后 6.2±1.8 个月，与 RVF 的 15.2±1.8 个月相比，差异有统计学意义（p<.001）。单因素分析显示，严重骨质疏松症（T 评分＜-3.0）、胸腰椎交界处椎体成形术、矢状面失平衡和节段后凸角＞15°是 AVF 的危险因素（p=0.029、p=0.033、p=0.001 和 p=0.021）。严重骨质疏松症（T 评分＜-3.0）和矢状面失平衡是 RVF 的危险因素（p=0.013 和 p=0.004）。多因素分析显示，胸腰椎交界处椎体成形术和矢状面失平衡是 AVF 的危险因素（风险比=3.34，p=0.032 和风险比=4.05，p=0.008），而只有矢状面失平衡是 RVF 的危险因素（风险比=2.66，p=0.024）。 结论：OVCF 椎体成形术后，新发 AVF 和 RVF 的发生时间存在显著差异，AVF 需 6 个月，RVF 需 15 个月。胸腰椎交界处椎体成形术是 AVF 的危险因素，而矢状面失平衡是 AVF 和 RVF 的共同危险因素。
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