Retrospective cohort study demonstrates key risk factors for refracture after percutaneous vertebroplasty, highlighting the importance of symmetric cement spread and adequate volume.
Key Points
To evaluate how bone cement volume, distribution patterns, and anatomical characteristics influence the risk of operated and adjacent vertebral refracture after percutaneous vertebroplasty.
Conducted a retrospective cohort study of 326 patients with single-level osteoporotic vertebral compression fractures who underwent unilateral percutaneous vertebroplasty between January 2018 and December 2022 with at least 12 months of follow-up.
Categorized patients into a refracture group (n = 62) and a non-refracture group (n = 264) to evaluate demographic, surgical, laboratory, and radiological parameters using univariate and binary logistic regression analyses.
The overall postoperative refracture rate was 19.0% (62/326).
Surgical factors independently associated with refracture included asymmetric cement distribution (Type IV: OR = 12.35, 95% CI: 4.26–35.78, P < 0.001; Type V: OR = 15.62, 95% CI: 5.41–45.13, P < 0.001), intervertebral cement leakage (OR = 5.82, 95% CI: 3.16–10.71, P < 0.001), and cement volume ≤ 3.0 mL (OR = 2.61, 95% CI: 1.43–4.76, P = 0.002).
Anatomical and metabolic independent risk factors included a bone mineral density T-value ≤ −3.5 (OR = 2.17, 95% CI: 1.19–3.96, P = 0.011) and pelvic incidence > 55° (OR = 1.89, 95% CI: 1.04–3.42, P = 0.036).