Lumbar posterior group muscle degeneration: Influencing factors of adjacent vertebral body re-fracture after percutaneous vertebroplasty

Lumbar localized fat distribution parameters are independent predictors of osteoporotic vertebral compression re-fractures (OVCRFs) following Percutaneous Kyphoplasty (PKP): a retrospective matched case-control study

OBJECTIVE

To investigate potential risk factors for osteoporotic vertebral compression re-fractures (OVCRFs) following percutaneous kyphoplasty (PKP).

MATERIALS AND METHODS

Patients who underwent PKP from January 2012 to January 2020 were included in this study within the same institution. Cases were defined as patients who experienced OVCRFs, while controls were matched based on corresponding clinical characteristics from those patients without OVCRFs. The lumbar localized fat distribution parameters, including the fat infiltration ratio (FIR) in muscles [multifidus (MF), erector spinae (ES), paravertebral muscles (PVM), and psoas major (PS)] and subcutaneous fat thickness (SFT), were compared between the two groups through radiological data. And other clinical data that may be relevant were also compared. Independent risk factors for OVCRFs after PKP were identified through a binary logistic regression analysis.

RESULT

A total of 1391 patients who underwent PKP were included in this study. 51 patients were categorized into the re-fracture group, and 102 patients were selected as matched controls from the remaining cohort. There were statistically significant differences between the two groups in metrics including MF-FIR, ES-FIR, PVM-FIR, PS-FIR, bone mineral density (BMD), body-mass index (BMI), SFT, hemoglobin (Hb), albumin (ALB), alkaline phosphatase (ALP), and triglycerides (TG) (P < 0.05). Binary logistic regression analysis demonstrated that PVM-FIR (P = 0.003), SFT (P < 0.001), BMD (P = 0.011), and ALP (P = 0.005) were independent predictors for the occurrence of OVCRFs.

CONCLUSION

This study discovered that lumbar localized fat distribution parameters including PVM-FIR and SFT are independent predictors of OVCRFs. Additionally, BMD and ALP were found to be independent predictors of OVCRFs.

What Risk Factors Are Associated With Recurrent Osteoporotic Vertebral Compression Fractures After Percutaneous Vertebral Augmentation? A Meta-analysis

BACKGROUND

Osteoporotic vertebral compression fracture (OVCF) has been extensively treated clinically using percutaneous vertebral augmentation (PVA), which includes percutaneous kyphoplasty and percutaneous vertebroplasty. Postoperative refracture is a common complication after PVA, but the associated factors and specific mechanisms behind these fractures are not entirely clear.

QUESTIONS/PURPOSES

In a systematic review and meta-analysis, we asked: What factors were associated with increased or decreased odds of refracture after PVA for OVCF?

METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines, we conducted a comprehensive search of the Cochrane Library, PubMed, Web of Science, and Embase for the time period from database inception to August 31, 2024 (which also was when we last searched). We included case-control studies in which participants were patients with OVCF and were treated with PVA, grouped into refracture versus non-refracture groups based on the presence or absence of refracture. We excluded studies published on preprint servers, conference reports, case reports, and systematic reviews or meta-analyses. We collected 2398 records in the database. After excluding studies that were duplicates and did not meet the inclusion criteria, we included 22 studies involving 7132 participants, 75% (5368) of whom were women, with a mean age of 76 years for patients in the refracture group and 74 years for patients in the non-refracture group. Quality assessment was performed using the Newcastle-Ottawa Scale, with which we assessed three aspects of the study; the mean ± SD score for the included studies was 7.3 ± 0.7 of 9 total (on this scale, higher scores are better), representing generally high study quality. The determination of heterogeneity relied on I2 and chi-square test, and we used a random-effects model when the I2 was > 50% and p ≤ 0.05; otherwise, a fixed-effects model was chosen. According to the Egger test and trim and fill method, publication bias did not significantly affect most of our results.

RESULTS

The combined results showed that older age (mean difference 2.24 [95% confidence interval (CI) 1.25 to 3.23]; p < 0.001), lower bone mineral density (BMD) (standardized mean difference [SMD] -0.72 [95% CI -0.99 to -0.45]; p < 0.001), greater preoperative AP vertebral height ratio (SMD 0.26 [95% CI 0.07 to 0.45]; p = 0.01), greater preoperative kyphotic angle (KA) (SMD 0.47 [95% CI 0.10 to 0.83]; p = 0.01), bone cement leakage (OR 1.39 [95% CI 1.05 to 1.84]; p = 0.02), multivertebral fractures (OR 3.58 [95% CI 2.53 to 5.07]; p < 0.001), smoking (OR 1.53 [95% CI 1.16 to 2.02]; p = 0.003), use of glucocorticoids (OR 3.18 [95% CI 2.09 to 4.84]; p < 0.001), and previous osteoporotic vertebral fracture (OR 2.55 [95% CI 1.58 to 4.13]; p < 0.001) were associated with increased odds of refractures after surgery. Use of antiosteoporosis therapy was associated with a decreased odds of postoperative refracture (OR 0.39 [95% CI 0.24 to 0.64]; p < 0.001).

CONCLUSION

Based on the results of our meta-analysis, surgeons can identify those who are more likely to have refracture by knowing basic information about their patients preoperatively, such as advanced age, lower BMD, greater preoperative AP ratio, greater preoperative KA, and the presence of multivertebral fractures or previous osteoporotic vertebral fracture. Also, intraoperative reduction of bone cement leakage and postoperative counseling of patients to quit smoking, reduce glucocorticoid use, and administration of antiosteoporosis therapy were used to reduce the probability of refracture. The association between some factors and refracture is uncertain, such as BMI and thoracolumbar fracture, and further studies are needed.

LEVEL OF EVIDENCE

Level III, therapeutic study.

CT-based radiomics predicts adjacent vertebral fracture after percutaneous vertebral augmentation

BACKGROUND

Adjacent vertebral fracture (AVF) is a frequent complication following percutaneous vertebral augmentation (PVA). While radiomics is widely utilized in the field of spinal medicine, its application for assessing the risk of AVF in post-PVA patients remains limited.

OBJECTIVE

We aim to develop and validate predictive models using machine learning algorithms for radiomics and clinical risk factors to assess the risk of AVF after PVA.

MATERIALS AND METHODS

This retrospective study included 158 patients with osteoporotic vertebral compression fractures who underwent PVA at our hospital, of which 48 patients had AVF within 2 years. The patients were divided into train and test cohorts in a ratio of 7:3. Radiomics features of the surgically intervened vertebrae were extracted from CT images, and selected using Mann-Whitney U-test and LASSO regression to construct a radiomic signature. Machine learning algorithms (SVM and LR) were then employed to integrate the radiomics signature with clinical data to develop predictive models. The performance of the model was assessed using Receiver Operating Characteristic (ROC) curves and calibration curves.

RESULTS

Nine optimal radiomics features were selected to form the radiomics model, while five clinical features were identified for the clinical model. The AUCs of the radiomics, clinical, and combined models developed using the SVM algorithm were 0.77, 0.77, and 0.83 on the test cohort, and those of the LR algorithm were 0.78, 0.81, and 0.86.

CONCLUSION

Radiomics and machine learning modeling using postoperative CT images demonstrate noteworthy capability in assessing the risk of AVF following PVA.

Risk factors for secondary vertebral compression fracture after percutaneous vertebral augmentation: a single-centre retrospective study

OBJECTIVE

To determine the incidence of secondary vertebral compression fracture (SVCF) after percutaneous vertebral augmentation (PVA) and its correlative risk factors, and to provide theoretical evidence for clinical practice.

METHODS

A retrospective analysis of 288 cases of PVA completed in our hospital from June 2020 to June 2023 was performed, and the patients were divided into the non-secondary vertebral compression fracture group (N-SVCF group) and the secondary vertebral compression fracture group (SVCF group) according to whether SVCF occurred during the postoperative follow-up review. Gender, age, body mass index (BMI), T value of bone mineral density (BMD-T), underlying diseases (hypertension, diabetes mellitus, coronary heart disease, chronic obstructive pulmonary disease), intravertebral vacuum cleft (IVC), amount of bone cement injected, classification of cement diffusion, anterior vertebral recovery ratio, local Cobb angle correction rate, leakage of bone cement into the intervertebral space, and fat infiltration rate (FIR) of paraspinal muscles were collected from the patients. The incidence and risk factors of SVCF after PVA were evaluated using univariate and multivariate logistic regression analysis, and the predictive value of the independent risk factors was evaluated using receiver operating characteristic curve (ROC) to determine the cut-off points at which they were meaningful for the development of SVCF.

RESULTS

In our study, the incidence of SVCF was 14.60% (42/288) in 288 patients who underwent PVA. Univariate analysis showed that age, BMI, fat infiltration rate of paraspinal muscles, cement leakage into the intervertebral space, unilateral/bilateral pedicle puncture approach and presence of IVC were statistically different between N-SVCF and SVCF (P < 0.05). Multifactorial regression analysis and ROC regression analysis revealed that the fat infiltration rate of the psoas major and erector spinae muscles, cement leakage into the intervertebral space, and IVC (P < 0.05) were risk factors for the incident of SVCF after PVA (P < 0.05). Psoas major (FIR) more than 5.490% and erector spinae (FIR) more than 52.413% had a high possibility of the occurrence of SVCF after PVA.

CONCLUSION

In this study, logistic regression combined with ROC curve analysis indicated that FIR of psoas major and erector spinae, cement leakage in the intervertebral space, and IVC were risk factors for the occurrence of SVCF after PVA. Psoas major (FIR) more than 5.490% and erector spinae (FIR) more than 52.413% had a high possibility of the occurrence of SVCF after PVA.

Analysis of the impact of underlying diseases in the elderly on postoperative re-fractures after osteoporotic compression fractures

BACKGROUND

Postoperative refracture of osteoporotic compression fractures in the elderly due to underlying illnesses is a complicated matter involving several variables. A multidisciplinary approach involving orthopedics, geriatrics, endocrinology, and rehabilitation medicine is necessary for an investigation of these issues. investigating the impact of older patients' underlying medical conditions on the refracture of osteoporotic compression fractures following surgery.

METHODS

A retrospective analysis was conducted on 2383 patients between August 2013 and August 2023. 550 patients with comorbid geriatric underlying diseases were screened, 183 patients underwent refractories, and 367 patients were classified as non-refractories. The patients were then divided into two groups: those undergoing refractories and those not, and the underlying diseases of the patients in both groups were examined using ROC curves and unifactorial and multifactorial logistic regression analyses.

RESULTS

Among the patients gathered, the frequency of re-fracture was 33.3%. A statistically significant difference was observed when re-fracture was linked to patients with long-term alcohol consumption, operated vertebrae ≤ 1, hypertension, COPD, diabetes mellitus, stroke sequelae, conservative treatment of coronary heart disease, trauma, mental abnormality, scoliosis, and chronic renal disease. Having hypertension decreased the risk of re-fracture (P = 0.018, OR = 0.548), while alcohol intake ≥ 10years (P = 0.003, OR = 2.165), mental abnormality (P < 0.001, OR = 4.093), scoliosis (P < 0.001, OR = 6.243), chronic kidney disease (P = 0.002, OR = 2.208), and traumatic injuries (P = 0.029, OR = 3.512) were the risk factors examined in a binary logistic regression analysis. The results of multiple linear stepwise regression analysis indicated that re-fracture was more influenced by scoliosis.

CONCLUSIONS

Hypertensive disorders were protective factors against the formation of re-fracture, while alcohol intake usage for more than ten years, psychological abnormalities, scoliosis, chronic kidney disease, and trauma were risk factors. Scoliosis had the highest influence on re-fracture.

Incidence and risk factors of adjacent vertebral fracture after percutaneous vertebroplasty or kyphoplasty in postmenopausal women: a retrospective study

Adjacent vertebral fracture (AVF) is a serious complication of percutaneous vertebroplasty (PVP) or kyphoplasty (PKP) for osteoporotic vertebral compression fracture (OVCF). This study aimed to explore the incidence and risk factors of AVF following PVP or PKP in postmenopausal women. The incidence of AVF was determined by spinal radiographic examinations. The potential risk factors of AVF were identified by univariate analysis, followed by multivariate logistic regression analyses to determine the independent risk factors. In total, 674 postmenopausal women who were treated with PVP or PKP from December 2019 to February 2022 were enrolled in the study. Among them, 58 (8.61%) women experienced an AVF following PVP or PKP. After adjusting for confounding factors, BMI (OR [95% CI] 0.863 [0.781-0.952]; p = 0.003), previous history of OVCF (OR [95% CI] 1.931 [1.044-3.571]; p = 0.036), and Hounsfield unit (HU) value (OR [95% CI] 0.979 [0.967-0.990]; p < 0.001) were found to be independent risk factors of AVF following PVP or PKP in postmenopausal women. The ROC analysis revealed that the BMI and HU thresholds were 21.43 and 65.15, respectively. In conclusion, the incidence of AVF was 8.61%. BMI, previous history of OVCF and HU value were independent risk factors of AVF following PVP or PKP in postmenopausal women.

Paraspinal muscle parameters' predictive value for new vertebral compression fractures post-vertebral augmentation: Nomogram development and validation

Objective

Prior research underscores the significance of paraspinal muscles in maintaining spinal stability. This study aims to investigate the predictive value of paraspinal muscle parameters for the occurrence of new vertebral compression fractures (NVCF) following percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) in patients with osteoporotic vertebral compression fractures (OVCF).

Methods

Retrospectively collected data from October 2019 to February 2021 (internal validation, n = 235) and March 2021 to November 2021 (external validation, n = 105) for patients with OVCF treated with PVP/PKP at our institution. They were randomly divided into training (188 cases) and validation groups (47 cases) at an 8:2 ratio. Lasso regression and multivariable logistic regression identified independent risk factors in the training set, and a Nomogram model was developed. Accuracy was assessed using receiver operating characteristic curves (ROC), calibration was evaluated with calibration curves and the Hosmer-Lemeshow test, and clinical utility was analyzed using decision curve analysis (DCA) and clinical impact curve (CIC).

Results

Surgical approach, spinal computed tomography (CT) values, and multifidus skeletal muscle index (SMI) are independent predictors of postoperative NVCF in OVCF patients. A Nomogram model, based on the identified predictors, was developed and uploaded online. Internal validation results showed area under the curve (AUC) values of 0.801, 0.664, and 0.832 for the training set, validation set, and external validation, respectively. Hosmer-Lemeshow goodness-of-fit tests (χ2 = 7.311-14.474, p = 0.070-0.504) and calibration curves indicated good consistency between observed and predicted values. DCA and CIC demonstrated clinical net benefit within risk thresholds of 0.06-0.84, 0.12-0.23, and 0.01-0.27. At specificity 1.00-0.80, the partial AUC (0.106) exceeded that at sensitivity 1.00-0.80 (0.062).

Conclusion

Compared to the spinal CT value, the multifidus SMI has certain potential in predicting the occurrence of NVCF. Additionally, the Nomogram model of this study has a greater negative predictive value.

Comparison of safety and efficacy of posterior lumbar interbody fusion (PLIF) and modified transforaminal lumbar interbody fusion (M-TLIF) in the treatment of single-segment lumbar degenerative diseases

OBJECTIVE

To compare modified transforaminal lumbar interbody fusion (M-TLIF) with posterior lumbar interbody fusion (PLIF) in the treatment of single-segment lumbar degenerative disorders in order to assess its safety and effectiveness.

METHODS

From January 2016 to January 2021, 74 patients who received single-segment M-TLIF were examined. A total of 74 patients having single-segment PLIF during the same time period were included in a retrospective controlled study using the same inclusion and exclusion criteria. The two groups were compared in terms of the fusion rate, the Oswestry disability index (ODI), the visual analogue scale of low back pain (VAS), the perioperative condition, the postoperative complications, and the postoperative neighbouring segment degeneration.

RESULTS

All patients had surgery satisfactorily and were monitored for at least a year afterwards. The baseline values for the two groups did not significantly differ. The interbody fusion rate between PLIF (98.65%) and M-TLIF (97.30%) was not significantly different. In the follow-up, the M-TLIF group's VAS score for low back and leg pain was lower than that of the PLIF group. The ODI score of the M-TLIF group was lower than that of the PLIF group at 7 days and 3 months following surgery. Both groups' post-op VAS and ODI scores for low back and leg pain were much lower than those from before the procedure. In M-TLIF group, the operation time, drainage tube extraction time, postoperative bed rest time and hospital stay time were shorter, and the amount of intraoperative blood loss was less. Compared with those before operation, the height of intervertebral space and intervertebral foramen were significantly increased in both groups during postoperative follow-up (P < 0.05). The postoperative complications and adjacent segment degeneration of M-TLIF were significantly lower than those of PLIF.

CONCLUSIONS

M-TLIF is a safe and effective treatment for lumbar degenerative disorders, with a high fusion rate and no significant difference between M-TLIF and PLIF. M-TLIF's efficacy and safety are comparable to that of PLIF, particularly in terms of early relief of low back pain and improvement in quality of life following surgery. Therefore, M-TLIF technology can be popularized and applied in clinic.

The Effect of Salmon Calcitonin Adjuvant Treatment for Lumbar Spine Fracture: A Prospective, Randomized, Controlled Trial

The study aimed at analyzing the therapeutic effect of salmon calcitonin on patients with lumbar spine fracture after operation. Eighty-eight cases with lumbar spine fracture who underwent percutaneous vertebroplasty (PVP) in The Huichang People's Hospital from February 2020 to February 2023 were separated into two groups. The 44 cases in the control group were treated with calcium carbonate and Vitamin D3 tablets, on the basis, the salmon calcitonin was applied to treat the 44 cases in study group. The pain degree, bone metabolism index and matrix metalloproteinase levels were determined and compared between two groups. Lumbar function and daily living activity ability in two groups were evaluated, and adverse reactions during treatment were observed. The pain degree in study group was alleviated after treatment for 3 mo compared with the control group (p<0.05). The bone specific alkaline phosphatase (BALP) and osteocalcin (OC) levels were increased, while beta C-terminal cross-linked telopeptides of type I collagen (β-CTX) levels were decreased in study group after treatment for 3 mo compared with control group (p<0.05). After treatment for 3 mo, the serum matrix metalloproteinase-3 (MMP-3) and matrix metalloproteinase-9 (MMP-9) levels in study group were lower than those in control group (p<0.05). Three months after treatment, the Oswestry Disability Index (ODI) score was lower and Barthel Index (BI) score was higher in study group than those of control group (p<0.05). No severe adverse reactions were observed in both groups during treatment (p>0.05). Salmon calcitonin can relieve the pain degree, improve the levels of bone metabolism and matrix metalloproteinase, and improve the lumbar spine function and ability of daily living activity in patients with lumbar spine fracture.

Comparison Between the Clinical Effect of Percutaneous Kyphoplasty for Osteoporosis Vertebral Compression Fracture Patient with or Without Sarcopenia: A Retrospective Cohort Study

Background

Sarcopenia and osteoporosis vertebral compression fractures (OVCF) are common diseases that increase with age. This study aimed to investigate the effects of sarcopenia on OVCF patients after percutaneous kyphoplasty (PKP).

Methods

Data of 101 patients who were treated with single-level PKP between January 2021 and March 2022 at Ningbo No.6 Hospital were enrolled. Forty-five OVCF patients with sarcopenia who met our inclusion criteria were included in the Sarcopenia-PKP group (SPKP group), and 56 patients in the Normal-PKP group (NPKP group). All clinical and radiological data were collected from medical records. Baseline characteristics, operation-related parameters (operation time, time to ambulation, hospital stay, surgery segment), clinical outcomes (visual analog score [VAS], Oswestry Disability Index [ODI], Japanese Orthopaedic Association Scores [JOA] of lumber), radiological outcomes (vertebral anterior height rate and local kyphosis angle), Macnab score, and complications were evaluated and compared.

Results

There were no significant differences in age, sex, surgical segment preoperative VAS score, ODI, or JOA between the two groups (P > 0.05). The SPKP group had a significantly lower body mass index (BMI), bone mineral density (BMD), and smooth muscle index (SMI) than the NPKP group (P < 0.05). Significantly longer hospital stays and time to ambulation in SPKP group than NPKP group (3.7±0.8 vs 3.4±0.5 and 2.0±0.8 vs 1.6±0.5, P < 0.05). In SPKP group, significantly better clinical outcomes at 6- and 12-months follow-up were observed in NPKP group than SPKP group (P < 0.05), and NPKP group showed significantly better in vertebral anterior height rates than SPKP group after 6-month follow-up (P < 0.05). Moreover, there were significantly more cases of complications in the SPKP group (P < 0.05).

Conclusion

Sarcopenia could reduce the clinical effect of percutaneous kyphoplasty, and furthermore. Related studies are needed to verify the effect of sarcopenia on OVCF patients.