What question did this study set out to answer?

This study aims to define preoperative cutoff values that predict mechanical failure in transpedicular intravertebral cage augmentation for osteoporotic vertebral fractures.

April 25, 2026Open Access

Radiological Cut-Off Values for Patient Selection in Intravertebral Cage Augmentation for Osteoporotic Vertebral Fractures: A Preliminary Study

WHWon-Suk HaIncheon St. Mary's Hospital MSMyung-Hoon ShinIncheon St. Mary's Hospital

Key Points

This study aims to define preoperative cutoff values that predict mechanical failure in transpedicular intravertebral cage augmentation for osteoporotic vertebral fractures.
Analyzed 24 patients undergoing intravertebral cage insertion for OVFs or Kummell disease, divided into mechanical complication (MC) and non-MC groups.
Performed receiver operating characteristic curve analysis to determine predictive cutoff values for mechanical failure.
Compared preoperative index height, pelvic incidence, and restoration ratios between MC and non-MC groups.
MC group had a lower preoperative index height (13.9 mm vs. 16.5 mm; p = 0.043) and a greater PI-LL mismatch (33.1 vs. 19.0; p = 0.026).
Significant predictors of mechanical failure included an index height of 12.7 mm (AUC = 0.756, p = 0.003) and a PI-LL mismatch of 22.9 (AUC = 0.756, odds ratio 12.0, p = 0.033).
Only the MC group showed significant loss of correction during follow-up (p = 0.020).

Abstract

Objective: Transpedicular intravertebral cage augmentation is a less invasive alternative to corpectomy for osteoporotic vertebral fractures (OVFs) with neurological deficits.However, because the intravertebral cage depends on the residual vertebral shell for support, objective criteria for patient selection remain undefined.This study aimed to identify preoperative cutoff values predictive of mechanical failure.Methods: Twenty-four patients who underwent transpedicular intravertebral cage insertion with posterior instrumentation for OVFs or Kmmell disease were divided into a mechanical complication (MC) group (n = 9) and a non-MC group (n = 15).Receiver operating characteristic curve analysis was performed to determine preoperative cutoff values. Results:The MC group had a lower preoperative index height (13.9 4.2 mm vs. 16.5 2.9 mm; p = 0.043) and a greater pelvic incidence (PI)-lumbar lordosis (LL) mismatch (33.1 17.3 vs. 19.0 11.7; p = 0.026) than the non-MC group.A preoperative index height of 12.7 mm (area under the curve AUC= 0.756, specificity = 1.000, p = 0.003) and a PI-LL mismatch of 22.9 (AUC = 0.756, odds ratio, 12.0, p = 0.033) were significant predictors of mechanical failure.All patients with an index height of 12.7 mm experienced failure.The MC group achieved a greater height restoration ratio (47.4% vs. 22.7%; p = 0.017) but reached a similar postoperative height (~20 mm, p = 0.811), with a strong inverse correlation between preoperative height and restoration ratio (r = -0.804,p < 0.001).Only the MC group showed a significant loss of correction during follow-up (p = 0.020). Conclusion:A preoperative index height of 12.7 mm and a PI-LL mismatch of 22.9 may serve as preliminary thresholds indicating the biomechanical limits of intravertebral cage augmentation.In severely collapsed vertebrae, the degree of correction required may exceed what the intravertebral cage can sustain, and these patients may therefore benefit from corpectomy.

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