Correlation of Sagittal Imbalance and Recollapse after Percutaneous Vertebroplasty for Thoracolumbar Osteoporotic Vertebral Compression Fracture: A Multivariate Study of Risk Factors

Abstract

This study aimed to assess the clinical significance of sagittal balance for predicting and managing the recollapse of cemented vertebra following percutaneous vertebroplasty (PVP) in patients with thoracolumbar osteoporotic vertebral fracture (OVF). Overview of Literature: Recently, the recollapse of cemented vertebra following PVP for OVF has been reported. Although the risk factors for recollapse have been determined, the association between sagittal spinopelvic parameters and sagittal imbalance with recollapse has not been established. Methods: Ambulatory patients who underwent single-level PVP for thoracolumbar OVF with a follow-up of at least 24 months were retrospectively reviewed. The patients were divided into two groups depending on the presence of symptomatic recollapse at the cemented vertebra: (1) recollapsed (RC) group and (2) noncollapsed (NC) group. The patient characteristics and radiographic measurements associated with sagittal imbalance were analyzed at each follow-up visit. Results: Overall, 134 patients (RC group, n=28; NC group, n=106) were enrolled. The mean fracture-free interval was 3.2 months (range, 1.2-25.1 months). The multivariate binary logistic regression analysis identified low bone mineral density (p=0.047), degree of dynamic mobility within the vertebra (p=0.025), and sagittal imbalance as significant risk factors for recollapse (p=0.013; odds ratio, 5.405). The progression of sagittal imbalance and thoracolumbar kyphosis (T10-L2) was more significant in the RC and sagittal imbalance groups than in the NC group (both p=0.000). Conclusions: Sagittal imbalance, lower bone mineral density, and dynamic mobility within the vertebra are associated with the recollapse of cemented vertebrae following PVP. Sagittal imbalance, rather than local kyphosis or thoracolumbar kyphosis, is particularly significant in that it results in more progressive collapse and sagittal deformity and is accompanied by substantial back pain and neurological deficits. Therefore, a stricter and more active management, including anti-osteoporosis medication, is required for the treatment of OVF with sagittal imbalance of the spine.

Risk factor analysis of the incidence of adjacent vertebral compression fracture following PKP surgery in postmenopausal women

“…The main reason may be that the morphological changes of the height or the kyphosis angle after surgery, the sheer force of the adjacent segments is increased, so that leading to increased risks of adjacent vertebral compression fracture. This result was also consistent with previous opinion reported by previous studies [32][33][34][35][36] . Subject to this study, we do not recommend for force the perfect recovery of vertebral height too much in the operation.…”

Pathophysiological mechanism of acute bone loss after fracture

“…Spinal fractures are often accompanied by varying degrees of kyphosis and changes in physiological curvatures of the spine, which makes the body's center of gravity to move forward. In addition, when stress of the anterior and middle columns of the vertebral body increases, vertebral fractures are more likely to occur [127] .…”

Risk factors for new vertebral compression fracture after vertebroplasty and efficacy of osteoporosis treatment: A STROBE-compliant retrospective study

“…Recently, several studies have analyzed the risk factors-decreased bone mineral density (BMD), cement leakage into the disc, sagittal imbalance, the presence of an intravertebral cleft, endplate cortical disruption, and the degree of restoration of the vertebral height-associated with SNVCFs after VP. [10][11][12][13][14][15] However, the results are contradictory and remain inconclusive. Furthermore, whether SNVCFs are caused by VP or by spontaneous progression of osteoporosis is yet to be confirmed.…”