45. Diffuse idiopathic skeletal hyperostosis is a risk factor of new adjacent compression fracture after percutaneous vertebroplasty

IF 2.5 Q3 Medicine

North American Spine Society Journal Pub Date : 2025-07-01 DOI:10.1016/j.xnsj.2025.100739

Yu-Cheng Yao MD , Po Wei Chen MD , Po-Hsin Chou MD , Bruce H Lin MD , Shih-Tien Wang MD

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Abstract

BACKGROUND CONTEXT

Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory spinal ossification condition that limits mobility and can cause stress concentration at fractures, leading to pseudoarthrosis or adjacent fractures. Nevertheless, limited research has specifically examined the relationship between DISH and adjacent fractures

PURPOSE

This study aims to examines the prevalence of new adjacent fractures following percutaneous vertebroplasty (PVP) in patients with and without DISH as a primary outcome. The secondary outcome is to identify additional risk factors associated with the development of new adjacent fractures after PVP.

STUDY DESIGN/SETTING

Retrospective cohort study

PATIENT SAMPLE

A total of 238 patients with single-level TL spine osteoporotic fractures who underwent PVP were analyzed.

OUTCOME MEASURES

Radiographic parameters, cement leakage, adjacent fractures and any revisions.

METHODS

We included patients with single-level TL spine osteoporotic fractures who underwent PVP between 2016 and 2021. Demographic, surgical, and radiographic data were collected, and follow-up X-rays were obtained for a minimum of 12 months. Adjacent fractures were defined as new vertebral fractures occurring at one level above or below the PVP level.

RESULTS

Among 238 cases analyzed, 59 (24.8%) had DISH. Adjacent fractures occurred in 27.3% of cases, with three instances requiring revisions due to neurological deficits. Patients with adjacent fractures were older, had more diabetes, and higher rates of DISH (38.5% vs. 19.7%, p=0.003). Identified risk factors included older age, DISH, type C cement leakage, and preoperative wedge angle. Patients with DISH are 2.3 times more likely to develop adjacent fractures compared to those without DISH. Furthermore, most adjacent fractures in DISH patients occurred when the DISH-PVP distance was = 2 levels (92.3%, p=0.007), with an overall incidence of 55% among DISH patients.

CONCLUSIONS

Older age, DISH, type C cement leakage, and preoperative wedge angle were significant risk factors for adjacent fractures post-PVP. These findings assist clinicians in patient discussions and highlight the potential benefits of implementing prophylactic strategies for high-risk individuals.

FDA Device/Drug Status

This abstract does not discuss or include any applicable devices or drugs.

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45. 弥漫性特发性骨骼增生是经皮椎体成形术后发生新的相邻压缩性骨折的危险因素

背景：弥漫性特发性骨骼肥厚症（DISH）是一种非炎症性脊柱骨化疾病，它限制了活动能力，并可在骨折处引起应力集中，导致假关节或邻近骨折。然而，有限的研究专门研究了DISH和邻近骨折之间的关系。本研究旨在研究作为主要结局的经皮椎体成形术（PVP）后伴有和不伴有DISH的患者新发邻近骨折的发生率。次要结果是确定与PVP术后新相邻骨折发生相关的其他危险因素。研究设计/设置回顾性队列研究患者样本：对238例接受PVP治疗的单节段TL脊柱骨质疏松性骨折患者进行分析。结果：影像学参数、骨水泥渗漏、邻近骨折及任何修复。方法我们纳入了2016年至2021年间接受PVP治疗的单节段TL脊柱骨质疏松性骨折患者。收集了人口统计学、外科和放射学数据，并进行了至少12个月的x光随访。相邻骨折被定义为发生在PVP水平以上或以下一个水平的新椎体骨折。结果238例患者中，59例（24.8%）有DISH。27.3%的病例发生相邻骨折，其中3例因神经功能缺损需要翻修。伴有相邻骨折的患者年龄较大，糖尿病患者较多，且DISH发生率较高（38.5%比19.7%,p=0.003）。确定的危险因素包括年龄较大、DISH、C型水泥渗漏和术前楔角。患有DISH的患者发生相邻骨折的可能性是没有DISH的患者的2.3倍。此外，在DISH患者中，当DISH- pvp距离为 = 2个水平时，大多数发生相邻骨折（92.3%,p=0.007）， DISH患者的总发生率为55%。结论焊龄、DISH、C型水泥渗漏、术前楔角是pvp术后邻近骨折发生的重要危险因素。这些发现有助于临床医生与患者进行讨论，并强调对高危人群实施预防策略的潜在益处。FDA器械/药物状态本摘要不讨论或包括任何适用的器械或药物。

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