Analysis Of Factors Related To Vertebral Height Loss After Percutaneous Kyphoplasty Or Percutaneous Vertebroplasty

Background:Compression fractures of the vertebral body are a common complication of osteoporosis.Currently,percutaneous vertebroplasty and percutaneous kyphoplasty are the main minimally invasive surgical methods for the treatment of osteoporotic vertebral compression fractures,which can effectively relieve lumbago and correct kyphosis.However,the vertebral height recovered by PKP/PVP surgery is prone to reloss after surgery,resulting in secondary compression of the vertebral body.The recurrence of low back pain and kyphotic deformity aggravation,nerve compression,serious impact on the patient’s quality of life,may require a second surgical intervention.At present,the factors of vertebral height reloss after PKP/PVP have been analyzed at home and abroad,and it is believed that bone density T value,level of fractured vertebral body,vertebral fissure sign,endplate contact,degree of vertebral injury,and distribution form and volume of bone cement are the main risk factors of vertebral height reloss.Paravertebral muscles are closely related to the vertebral body both spatially and functionally,and are very important for maintaining the biological stability of the spine.Studies have reported that sarcopenia is significantly correlated with osteoporotic vertebral compression fractures.In this study,paravertebral muscles were included as the dependent variable to further analyze the factors related to the reloss of vertebral height during surgery.Objective:PKP/PVP is the main minimally invasive surgical method for osteoporotic vertebral compression fractures.Reloss of vertebral height often occurs in senile patients with osteoporotic fractures after PKP/PVP,which affects the therapeutic effect.The purpose of this study was to investigate the risk factors of reloss of the injured vertebral height after percutaneous vertebroplasty or percutaneous kyphoplasty in patients with OVCF through retrospective analysis,so as to provide guidance for the surgical efficacy and postoperative rehabilitation of patients.Methods:Retrospective analysis was performed on patients diagnosed with osteoprestic vertebral compression fracture and hospitalized for PKP/PVP surgery in the First Affiliated Hospital of Nanchang University from May 2018 to May 2021.A total of174 patients(34 in the highly lost group and 140 in the non-highly lost group)were selected according to the inclusion and exclusion criteria.The following variables were selected for analysis: gender,age,height,weight,Body Mass Index,Bone Mineral Density,length of stay and Relative functional cross-sectional analysis area,Relative gross cross sectional area,surgical parameters(including surgical approach,cement shape,cement leakage,whether the cement touched the endplates on both sides,anterior vertebral margin height before,after,and at the last follow-up,and Cobb Angle before,after,and at the last follow-up),fracture level,whether there was standard continuous anti-osteoporosis therapy,refracture operation,and the patient’s VAS before and after surgery and at the last follow-up.Bivariate logistic regression analysis was used to determine the relative risk of reloss of bone cement vertebral height.Results:174 patients with OVCF were enrolled in the First Affiliated Hospital of Nanchang University according to inclusion and exclusion criteria.Univariate analysis showed that there were significant differences in fracture site,r FCSA,r GCSA,and contact between bone cement and endplate between the two groups(P <0.05).Bivariate Logistic regression analysis showed that spinal fracture site,r FCSA and r GCSA were risk factors for postoperative vertebral collapse.Conclusion:In PKP/PVP treated OVCF patients,contact between bone cement and upper and lower endplates,r FCSA,and r GCSA are high risk factor for reloss of vertebral height after surgery.For patients with paraspinal sarcopenia,spinal surgeons should pay attention to preoperative and postoperative nutritional guidance,anti-osteoporosis therapy,and back muscle exercises to minimize the risk of reloss of the surgically operated vertebral height.