Hirsch Joshua A, Gilligan Christopher, Chandra Ronil V, Brook Allan, Gasquet Nicolas C, Ricker Christine N, Wu Charlotte
Department of Interventional Neuroradiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA.
Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA.
Osteoporos Int. 2025 Jan;36(1):129-140. doi: 10.1007/s00198-024-07294-z. Epub 2024 Nov 23.
The purpose of this study was to determine the real-world incidence and predictors of additional vertebroplasty or balloon kyphoplasty after initial vertebral augmentation, as a proxy for subsequent symptomatic vertebral fracture. Of patients, 15.5% underwent subsequent vertebral augmentation. The patient's comorbidities are strongly associated with risk of subsequent treatment.
To determine the real-world incidence and predictors of additional vertebroplasty or balloon kyphoplasty after initial vertebral augmentation, as a proxy for subsequent symptomatic and disabling vertebral fracture.
We conducted a retrospective cohort study using commercial insurance claims data (Optum's de-identified Clinformatics® Data Mart Database). Adult patients who underwent subsequent treatment for vertebral fracture within 24 months of initial balloon kyphoplasty (BKP) or vertebroplasty (VP) were classified into "subsequent treatment" or "no subsequent treatment" cohorts. Survival analysis was applied to investigate the effect of risk factors on subsequent treatment.
Between 1 January 2008 and 30 June 2020, a total of 32,513 adult patients underwent a BKP/VP procedure following a diagnosis of vertebral compression fracture in the preceding 12 months. Five thousand thirty-five patients (15.5%) underwent a subsequent BKP/VP treatment within 2 years; 90% had a single fracture level treated. An increased hazard of subsequent treatment was associated with a number of fractures treated at initial BKP/VP (≥ 4 levels, adjusted hazard ratio (AHR) 1.68 (95% CI 1.24-2.26); steroid use, AHR 1.9 (95% CI 1.31-1.48); Elixhauser Comorbidity Index ≥ 4, AHR 1.44 (95% CI 1.17-1.77); and multiple myeloma, AHR 1.31 (95% CI 1.13-1.53)). Age < 70 years was associated with reduced hazard of subsequent treatment (AHR 0.81, 95% CI 0.74-0.89).
One in seven patients underwent subsequent treatment for vertebral fracture after initial vertebral augmentation. Baseline patient characteristics were associated with increased risk of subsequent fracture within 2 years, suggesting that a patient's natural history is strongly associated with risk of subsequent treatment rather than the initial surgical procedure itself.
本研究的目的是确定初次椎体强化术后再次进行椎体成形术或球囊扩张椎体后凸成形术的真实世界发生率及预测因素，以此作为后续症状性椎体骨折的替代指标。在患者中，15.5%接受了后续椎体强化术。患者的合并症与后续治疗风险密切相关。
确定初次椎体强化术后再次进行椎体成形术或球囊扩张椎体后凸成形术的真实世界发生率及预测因素，以此作为后续症状性和致残性椎体骨折的替代指标。
我们使用商业保险理赔数据（Optum的去识别化临床信息学数据集市数据库）进行了一项回顾性队列研究。在初次球囊扩张椎体后凸成形术（BKP）或椎体成形术（VP）后24个月内接受椎体骨折后续治疗的成年患者被分为“后续治疗”或“无后续治疗”队列。应用生存分析来研究风险因素对后续治疗的影响。
在2008年1月1日至2020年6月30日期间，共有32,513名成年患者在先前12个月被诊断为椎体压缩骨折后接受了BKP/VP手术。5035名患者（15.5%）在2年内接受了后续BKP/VP治疗；90%的患者仅治疗了单个骨折节段。后续治疗风险增加与初次BKP/VP治疗的骨折节段数量（≥4个节段，调整后风险比（AHR）1.68（95%CI 1.24 - 2.26））、使用类固醇（AHR 1.9（95%CI 1.31 - 1.48））、埃利克斯豪泽合并症指数≥4（AHR 1.44（95%CI 1.17 - 1.77））以及多发性骨髓瘤（AHR 1.31（95%CI 1.13 - 1.53））有关。年龄<70岁与后续治疗风险降低有关（AHR 0.81，95%CI 0.74 - 0.89）。
七分之一的患者在初次椎体强化术后接受了椎体骨折的后续治疗。基线患者特征与2年内后续骨折风险增加有关，这表明患者的自然病史与后续治疗风险密切相关，而非初次手术本身。
