Correlation Of Endplate Fractures With Height Loss Of Injured Vertebral Body,Kyphosis And Chronic Pain After Vertebral Augmentation

Objective:To explore the effects of endplate fractures on the loss of injured vertebral height,kyphosis and chronic pain after percutaneous vertebroplasty/percutaneous kyphoplasty.Methods:To retrospectively investigate the medical records of 82 patients with osteoporotic vertebral compression fractures who underwent vertebral intensive treatment.The patients were divided into three groups basing on the presence or absence of endplate fractures: unfractured group,superior vertebral endplate fracture group,and inferior endplate fracture group.Measure and calculate the patient’s injured vertebral compression rate,injured vertebral height recovery rate and Cobb angle,and record the pain visual analog score,bone density,bone cement diffusion type,and bone cement leakage.Univariate analysis and chi-square test were used to analyze whether endplate fractures were related to postoperative injury vertebral height loss,kyphosis and chronic pain,and the influence of endplate fractures on the distribution of bone cement.Results:(1)In the three groups of patients,the height of the injured vertebrae and kyphosis were improved.In the last followup,a significant decrease in the anterior height of the injured vertebral body and a significant increase in the Cobb angle were observed.The loss rate of the injured vertebral height and the Cobb angle of the endplate fracture group were higher than those of the non-endplate fracture group(P <0.05).(2)Compared with the preoperative visual analog scores,the three groups were not significantly different before surgery(P> 0.05),and the postoperative visual analog scores of the three groups were significantly lower than those before the operation(P <0.05),but the visual analog scores at the last follow-up of the two groups with endplate fractures were higher than those after surgery,while the final follow-up visual analog scores of the group without endplate fractures were not significantly different from the postoperative visual analog scores(P > 0.05).(3)The proportion of bone cement masses and the bone cement not contacting the two endplates at the same time was higher in the superior vertebral and inferior endplate fracture groups than that of the non-endplate fracture group(P < 0.05).There was no between the groups with insufficient bone cement distribution at the fracture site(P > 0.05).Conclusion:It is suggested that percutaneous vertebroplasty/percutaneous kyphoplasty can significantly improve the height of injured vertebrae,kyphosis and pain.However,long-term endplate fractures after surgery are not only related to the increased incidence of postoperative vertebral height loss and kyphosis,but also an important cause of chronic pain in patients.Other factors that affect the long-term loss of vertebral body height and the occurrence of kyphosis include the degree of bone cement dispersion,bone density,surgical methods,and bone cement materials.The degree of bone cement dispersion is affected by endplate fractures,and the lower the bone density,the more likely to fracture the endplate.Therefore,surgery should not only restore the compression height of the injured vertebrae and correct the kyphosis,but also correct the deformity of the endplate to effectively treat patients with endplate fractures.