Risk Factors for Bone Cement Leakage and Re-fracture Following PKP in Patients With Thoracolumbar Spine Fractures

AIM: Thoracolumbar spine fractures are commonly treated with percutaneous kyphoplasty (PKP), but bone cement leakage and re-fracture remain major concerns. Identifying their risk factors is essential for improving prognosis but remains insufficiently characterized. This study was designed to explore the risk factors for bone cement leakage and re-fracture following PKP in patients with thoracolumbar spine fractures. METHODS: A retrospective analysis was conducted on 115 patients with thoracolumbar spine fractures who underwent PKP at Heilongjiang Provincial Hospital between April 2022 and February 2025 (leakage group: 18 patients with bone cement leakage; non-leakage group: 97 patients without leakage). Risk factors for bone cement leakage were analyzed. Patients were divided into re-fracture (29 cases with re-fractures) and non-re-fracture (86 cases without re-fractures) groups to identify risk factors for postoperative re-fracture. RESULTS: Logistic multivariate regression analysis identified age and vertebral wall destruction as independent risk factors for postoperative bone cement leakage (p < 0.05). Separately, age, the degree of vertebral compression, and vertebral wall destruction were identified as independent risk factors for re-fracture after surgery (p < 0.05). CONCLUSIONS: Age and vertebral wall destruction are independent predictors of cement leakage, and together with compression severity, also predict re-fracture. These findings support routine preoperative assessment of vertebral wall integrity using high-resolution computed tomography (CT), particularly in elderly patients, as vertebral wall destruction was independently associated with bone cement leakage.