Refracture and Morphologic Classification in Osteoporotic Vertebral Compression Fractures After Percutaneous Kyphoplasty: A Retrospective Observational Study.

Abstract

Study design: This study is a clinical retrospective case-control study.

Summary of background data: Percutaneous kyphoplasty (PKP) is a common treatment for osteoporotic vertebral compression fractures (OVCF). It is effective in relieving pain and restoring vertebral height, but it can also lead to new compression fractures in other vertebrae.

Objective: To investigate whether the type of OVCF affects the risk of refracture after PKP and to identify other risk factors for refracture.

Methods: The study included 3676 patients with OVCF who had undergone PKP. They were divided into 2 groups: those who experienced refractures and those who did not. Fractures were classified into 4 types based on magnetic resonance imaging (MRI) signals. The study used univariate and multivariate logistic regression analyses to assess factors such as fracture type, gender, age, bone cement leakage, and Hounsfield-unit (HU) value.

Results: There were 157 patients in the refracture group (type I, 51 cases; type II, 23 cases; type III, 44 cases; type IV, 39 cases). And 3,519 patients in the nonrefracture group (type I, 1464 cases; type II, 637 cases; type III, 1063 cases; type IV, 355 cases). Intra-group analysis showed that the distribution of type I and type IV fractures between the 2 groups was statistically different. The results of the multivariate analysis showed that the morphologic classification of fractures, age, gender, bone cement leakage, and HU values were independent risk factors for refracture after PKP.

Conclusion: The risk of refracture after PKP in patients with OVCF is influenced by the fracture type. Among the different types, type IV has the highest risk of refracture after PKP.