Çevik Serdar, Tekin Abdurrahim, Can Engin, Duran Harun, Sönmez Evren, Ayhan Lokman, Dilbaz Suna, Öztürk Akin, Ünsal Ülkün Ünlü, Baş Serdar Nuri
Department of Neurosurgery, İstanbul Kanuni Sultan Süleyman Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
Department Neurosurgery, Manisa City Hospital, Manisa, Turkey.
Medicine (Baltimore). 2025 Aug 29;104(35):e44096. doi: 10.1097/MD.0000000000044096.
Osteoporotic vertebral compression fractures (OVCF) are a common complication of osteoporosis, particularly in elderly populations. Percutaneous kyphoplasty (PKP) is a minimally invasive procedure that provides pain relief and spinal stability for patients with OVCF. However, new vertebral compression fractures (NVCF) can occur in 2% to 38% of patients following PKP, posing a significant clinical challenge. Identifying risk factors for NVCF is essential to improve patient outcomes and guide preventive strategies. A retrospective study was conducted on 193 patients aged 60 years or older who underwent PKP for OVCF at a tertiary hospital between January 2017 and December 2023. Patients were divided into 2 groups based on the occurrence of NVCF during follow-up. Preoperative imaging (CT, X-ray, and MRI) and hospital records were analyzed to assess risk factors, including age, gender, bone mineral density, Hounsfield unit (HU) values, paraspinal muscle degeneration, cement volume, and leakage. Statistical analyses were performed using SPSS software, with multivariate regression analysis identifying independent predictors of NVCF. Among the 193 patients, 23.3% (n = 45) developed NVCF during follow-up, while 76.7% (n = 148) did not. Lower HU values (mean 58.1 ± 18.68 vs 79.5 ± 25.44, P = .0001) and increased fatty infiltration of paraspinal muscles were identified as significant independent risk factors for NVCF. Multivariate regression analysis confirmed lower HU values (OR = 0.965, P < .001) and fatty infiltration of the erector spinae muscle (OR = 1.034, P = .038) as predictors. Other factors, such as age, gender, bone mineral density, cement volume, and leakage, were not significantly associated with NVCF. Lower HU values and paraspinal muscle degeneration, particularly reduced functional muscle mass and increased fatty infiltration, are significant predictors of NVCF following PKP. Preoperative evaluations should include HU measurements and paraspinal muscle assessments to identify high-risk patients. Postoperative management should focus on improving bone density and muscle health through targeted therapies and lifestyle modifications to reduce fracture risk.
骨质疏松性椎体压缩骨折（OVCF）是骨质疏松症的常见并发症，在老年人群中尤为常见。经皮椎体后凸成形术（PKP）是一种微创手术，可为OVCF患者缓解疼痛并提供脊柱稳定性。然而，PKP术后2%至38%的患者可能会发生新的椎体压缩骨折（NVCF），这构成了重大的临床挑战。识别NVCF的危险因素对于改善患者预后和指导预防策略至关重要。对2017年1月至2023年12月期间在一家三级医院接受PKP治疗OVCF的193例60岁及以上患者进行了一项回顾性研究。根据随访期间NVCF的发生情况将患者分为两组。分析术前影像学检查（CT、X线和MRI）及医院记录以评估危险因素，包括年龄、性别、骨密度、亨氏单位（HU）值、椎旁肌退变、骨水泥体积和渗漏情况。使用SPSS软件进行统计分析，多因素回归分析确定NVCF的独立预测因素。在193例患者中，23.3%（n = 45）在随访期间发生了NVCF，而76.7%（n = 148）未发生。较低的HU值（平均58.1±18.68 vs 79.5±25.44，P = 0.0001）和椎旁肌脂肪浸润增加被确定为NVCF的重要独立危险因素。多因素回归分析证实较低的HU值（OR = 0.965，P < 0.001）和竖脊肌脂肪浸润（OR = 1.034，P = 0.038）为预测因素。年龄、性别、骨密度、骨水泥体积和渗漏等其他因素与NVCF无显著相关性。较低的HU值和椎旁肌退变，尤其是功能性肌肉量减少和脂肪浸润增加，是PKP术后NVCF的重要预测因素。术前评估应包括HU测量和椎旁肌评估以识别高危患者。术后管理应通过针对性治疗和生活方式改变来改善骨密度和肌肉健康，以降低骨折风险。
