Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
Pain Physician. 2021 Jul;24(4):E493-E500.
Subsequent vertebral fracture (SVF) is one of the most common complications of percutaneous vertebral augmentation (PVA), which leads to lower back pain in patients. Low bone mineral density (BMD) is an independent risk factor for SVF. BMD measured using computed tomography (CT) trabecular attenuation correlates closely with BMD.
This study aims to analyze the risk factors of SVF after PVA and to estimate the predictive role of CT trabecular attenuation.
A retrospective review.
Department of spinal surgery in an affiliated hospital of a medical university.
A total of 515 patients were retrospectively enrolled between January 2015 and December 2019 into a 5-year follow-up investigation. Trabecular attenuation (Hounsfield units [HU]) was retrospectively measured at L1 on preoperative lumbar or thoracic CT scans, and the receiver operating characteristic (ROC) curve was used to evaluate its value for the prediction of SVF. Kaplan-Meier analysis and Cox proportional hazards regression were performed to identify the risk factors for SVF.
A total of 166 patients (32.2%) experienced SVF. ROC curve analysis demonstrated that an L1 trabecular attenuation of <= 95 HU has a sensitivity of 70.5% and a specificity of 79.9% for the prediction of SVF. Kaplan-Meier analysis showed that L1 trabecular attenuation <= 95 HU was significantly associated with lower SVF-free survival (P = 0.001; log-rank test). Multivariate analysis demonstrated that advanced age (hazard ratio [HR] = 1.03, P = 0.022), low body mass index (HR = 0.83, P = 0.001), diabetes status (HR = 1.50, P = 0.024), antiosteoporosis drugs use (HR = 0.65, P = 0.031), and decreased L1 trabecular attenuation (HR = 0.95, P = 0.001) were risk factors for SVF.
A single-center retrospective study of a consecutive cohort of patients may include the inevitable bias. We periodically reviewed the full-length x-ray of the spine at every 3 months of follow-up visit, which we may miss some patients with SVF without low back pain.
SVF is highly prevalent in patients with osteoporotic vertebral fracture who undergo single-level PVA. Low L1 trabecular attenuation is associated with a significant reduction in SVF-free survival, and when their L1 trabecular attenuation is <= 95 HU, patients may be at higher risk of SVF.
Computed tomography, Hounsfield units, vertebral fracture, osteoporosis, percutaneous vertebral augmentation.
经皮椎体强化术（PVA）后发生的后继椎体骨折（SVF）是最常见的并发症之一，可导致患者出现腰痛。低骨密度（BMD）是 SVF 的独立危险因素。使用计算机断层扫描（CT）的小梁衰减测量的 BMD 与 BMD 密切相关。
本研究旨在分析 PVA 后 SVF 的危险因素，并评估 CT 小梁衰减的预测作用。
回顾性研究。
医科大学附属医院脊柱外科。
对 2015 年 1 月至 2019 年 12 月期间进行了为期 5 年随访的 515 例患者进行了回顾性研究。回顾性测量术前腰椎或胸椎 CT 扫描的 L1 处小梁衰减（Hounsfield 单位 [HU]），并使用受试者工作特征（ROC）曲线评估其对 SVF 预测的价值。采用 Kaplan-Meier 分析和 Cox 比例风险回归分析确定 SVF 的危险因素。
共有 166 例患者（32.2%）发生 SVF。ROC 曲线分析表明，L1 小梁衰减<=95 HU 对 SVF 的预测具有 70.5%的灵敏度和 79.9%的特异性。Kaplan-Meier 分析显示，L1 小梁衰减<=95 HU 与较低的 SVF 无复发生存率显著相关（P=0.001；对数秩检验）。多变量分析表明，年龄较大（风险比 [HR]=1.03，P=0.022）、较低的体重指数（HR=0.83，P=0.001）、糖尿病状态（HR=1.50，P=0.024）、使用抗骨质疏松药物（HR=0.65，P=0.031）和 L1 小梁衰减降低（HR=0.95，P=0.001）是 SVF 的危险因素。
这是一项单中心回顾性研究，连续队列的患者可能存在不可避免的偏倚。我们在每次随访的 3 个月定期复查脊柱全长 X 线片，这可能会错过一些没有腰痛的 SVF 患者。
骨质疏松性椎体骨折患者行单节段 PVA 后 SVF 发生率较高。L1 小梁衰减降低与 SVF 无复发生存率显著降低相关，当 L1 小梁衰减<=95 HU 时，患者发生 SVF 的风险可能更高。
计算机断层扫描，Hounsfield 单位，椎体骨折，骨质疏松症，经皮椎体强化术。
