Analysis Of Risk Factors For Adjacent Vertebrae Re-fracture After Vertebroplasty

Objective:A retrospective study was performed on patients with osteoporosis vertebral compression fracture(OVCF)who underwent vertebroplasty to analyze the risk factors for re-fracture of the adjacent vertebrae.Methods: Retrospective analysis of 221 patients who underwent single-segment vertebroplasty for OVCF from June 2016 to June 2018,and collected the factors that may lead to re-fracture,such as age,sex,height,weight,Body Mass Index(BMI),history of vertebral fractures,fracture location(thoracolumbar,non-thoracolumbar),bone mineral density(BMD)T value,preoperative vertebral height,postoperative vertebral height,vertebral height recovery rate,preoperative kyphosis angle,postoperative kyphosis angle,local kyphosis correction angle,bone cement dispersion type(bone cement exudation to intervertebral space,bone cement contact upper and lower endplates,bone cement side distribution),bone cement volume,bone cement puncture route(unilateral,bilateral),surgical methods,anti-osteoporosis treatment(Basic medication,namely calcitriol+Calc D;basic medication+teriparatide),wearing time of waist brace,Visual Analogue Scale/Score(VAS),VAS score on the first postoperative day,VAS score change before and after surgery.Univariate analysis was performed using t test and ?2 test to identify possible risk factors for postoperative recurrence of adjacent vertebrae.Logistic regression analysis was then used for multivariate analysis to determine the risk factors for recurrent fractures in the adjacent vertebrae.Results: Of the 221 patients treated with vertebroplasty,35(15.8%)had re-fractures,including 22(9.95%)with adjacent vertebrae and 3 with men in the adjacent vertebrae fracture group.There were 13 cases of non-adjacent vertebrae fractures,including 2 males and 11 females.There were 208 patients,including adjacent vertebral re-fracture and non-re-fracture patients.Univariate analysis found that the bone density T value,the vertebral body height recovery rate,the local kyphosis correction angle,the bone cement exudation to the intervertebral space,the bone cement simultaneously contact the upper and lower endplates,the lateral distribution of the bone cement,anti-osteoporosis treatment(basic medication,basic medication+teriparatide)P value was <0.05,and the difference was statistically significant.The age,gender,bone cement volume,vertebral fracture history,waist brace wear time,surgical procedure,surgical site,puncture route,VAS score change before and after surgery P value >0.05,the difference was not statistically significant.The above statistically significant factors were analyzed by logistic multivariate regression analysis finding that the bone density T value,the height recovery rate of the vertebral body,the exudation of the cement to the intervertebral space,the bone cement at the same time contacting the upper and lower endplates,and the lateral distribution of the bone cement P Value <0.05,the difference was statistically significant.There was no significant difference in the multi-factor analysis between the anti-osteoporosis treatment(basic medication,basic medication+teriparatide)and the local kyphosis correction angle.Conclusion: The decrease of bone density,vertebral height recovery rate is too large,bone cement exudation to intervertebral space,bone cement contact with upper and lower endplates,and lateral distribution of bone cement may be risk factors for adjacent vertebrae fracture after vertebroplasty.Therefore,we should adhere to reasonable anti-osteoporosis treatment,appropriate calcium and vitamin D supplementation,and should be carefully operated during the operation,to minimize bone cement intervertebral space leakage and reduce bone cement contact with vertebral endplates,to make the cement evenly spread in the vertebral body,to reduce the incidence of postoperative adjacent vertebrae re-fracture.