No more vertebroplasty for acute vertebral compression fractures?

Davies, Evan

doi:10.1136/bmj.k1756

Cited by 2 publications

(1 citation statement)

References 14 publications

(11 reference statements)

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“…Although limited to patients with severe ongoing pain after a recent unhealed fracture, vertebral augmentation is widely used as a minimally invasive and fast-acting treatment option. [6][7][8] however, there is increasing concern about the association between vertebral augmentation and early postoperative adjacent vertebral fractures (AVFs), 9,10 the incidence of which is approximately 20%. 6 this has led to considerable interest in predicting the occurrence of AVF, so that high-risk patients can be identified and then undergo vertebral augmentation, while at the same time making it possible to identify low-risk patients who can then proceed to treatment.…”

Section: Cite This Article: Bone Joint J 2022;104-b(1):97-102 Introductionmentioning

confidence: 99%

Development and internal validation of a clinical prediction model for acute adjacent vertebral fracture after vertebral augmentation

Hijikata

Kamitani

Nakahara³

et al. 2022

The Bone & Joint Journal

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Aims To develop and internally validate a preoperative clinical prediction model for acute adjacent vertebral fracture (AVF) after vertebral augmentation to support preoperative decision-making, named the after vertebral augmentation (AVA) score. Methods In this prognostic study, a multicentre, retrospective single-level vertebral augmentation cohort of 377 patients from six Japanese hospitals was used to derive an AVF prediction model. Backward stepwise selection (p < 0.05) was used to select preoperative clinical and imaging predictors for acute AVF after vertebral augmentation for up to one month, from 14 predictors. We assigned a score to each selected variable based on the regression coefficient and developed the AVA scoring system. We evaluated sensitivity and specificity for each cut-off, area under the curve (AUC), and calibration as diagnostic performance. Internal validation was conducted using bootstrapping to correct the optimism. Results Of the 377 patients used for model derivation, 58 (15%) had an acute AVF postoperatively. The following preoperative measures on multivariable analysis were summarized in the five-point AVA score: intravertebral instability (≥ 5 mm), focal kyphosis (≥ 10°), duration of symptoms (≥ 30 days), intravertebral cleft, and previous history of vertebral fracture. Internal validation showed a mean optimism of 0.019 with a corrected AUC of 0.77. A cut-off of ≤ one point was chosen to classify a low risk of AVF, for which only four of 137 patients (3%) had AVF with 92.5% sensitivity and 45.6% specificity. A cut-off of ≥ four points was chosen to classify a high risk of AVF, for which 22 of 38 (58%) had AVF with 41.5% sensitivity and 94.5% specificity. Conclusion In this study, the AVA score was found to be a simple preoperative method for the identification of patients at low and high risk of postoperative acute AVF. This model could be applied to individual patients and could aid in the decision-making before vertebral augmentation. Cite this article: Bone Joint J 2022;104-B(1):97–102.

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