Risk factors and strategies for recovery quality, postoperative pain, and recurrent fractures between percutaneous kyphoplasty and percutaneous vertebroplasty in elderly patients with thoracolumbar compression fractures: a retrospective comparative cohort study

Abstract

Background With the increase of clinical cases and the improvement of operation, we found that recurrent fracture of the adjacent vertebral body is a common long-term complication of percutaneous kyphoplasty (PKP). However, the mechanism of re-fracture of adjacent vertebrae after PKP has not been unified. Therefore, through retrospective study, this paper discussed the risk factors and countermeasures affecting the quality of rehabilitation, postoperative pain and recurrent fracture in elderly PKP patients. Methods From December 2019 to May 2021, 313 patients with osteoporotic spinal fractures were analyzed retrospectively. Cases were allocated to percutaneous vertebroplasty (PVP; n=130) and PKP (n=183) groups according to the modes of operation. Visual analogue scale (VAS), Cobb angle, and Oswestry disability index (ODI) were evaluated. Based on the occurrence of new fractures, the PKP cohort (n=15) and control cohort (n=32) were classified. Questionnaires analyzed the postoperative re-fractures of people with different characteristics, and the influencing factors of postoperative re-fracture were measured by multivariate logistic regression analysis. Results The postoperative VAS scores were significantly lower in the PKP group. The ODI scores in the PKP group were considerably lower than those in the PVP group after surgery. Univariate analysis indicated that age, number of injured vertebrae, history of complicated fracture, number of operative vertebrae, and bone mineral density (BMD) were remarkably correlated with recurrent fracture after PKP. Logistic regression analysis indicated that age, operative vertebral body, BMD, and the number of injured vertebrae were independent risk factors for recurrent fracture after PKP. BMI, BMD, low back soft tissue injury, postoperative vertebral height recovery rate, sagittal Cobb angle improvement rate, total diffusion coefficient of bone cement, short-term complications, non-union, and recurrent fracture were the main risk factors of residual low back pain after PKP. Conclusions The clinical efficacy of PKP in elderly patients with thoracolumbar vertebral compression fracture is superior to that of PVP. Clinical attention should be paid to identifying high-risk factors for complications after PKP, and preventive measures should be implemented to help reduce the occurrence of recurrent fractures and postoperative residual pain.

A study on vertebral refracture and scoliosis after percutaneous kyphoplasty in patients with osteoporotic vertebral compression fractures

“…Thirty-seven patients (13.8%) experienced vertebral refracture. We compared the data between the refractured group and the non-refractured group to determine the significant risk factors identified previously [ 11 , 14 , 17 ]. Bone cement leakage was not observed in 269 patients and was not analyzed in this study.…”

“…Although the advantages of PKP have been well demonstrated, vertebral refractures after PKP have been reported at rates ranging from 10 to 29.4%, affecting both adjacent and distant vertebrae [ 8 – 10 ]. There are many risk factors for refractures after PKP [ 11 ], and sagittal spinal imbalance has been acknowledged as the predominant contributor in previous studies [ 8 , 12 – 14 ]. In our prior research, however, we observed a high prevalence of osteoporosis among patients aged > 50 years who underwent spinal surgery, especially among those primarily diagnosed with degenerative scoliosis [ 15 ].…”