Risk factors for progressive kyphosis after percutaneous kyphoplasty in osteoporotic vertebral compression fracture.

Abstract

Purpose: To investigate the risk factors associated with progressive kyphosis (PK) after percutaneous kyphoplasty (PKP) in osteoporotic vertebral compression fractures (OVCFs).

Methods: A single-center retrospective study (January 2020 to December 2022) analyzed 129 OVCF patients treated with PKP. Patients were divided into a PK group and a non-progressive kyphosis group. Clinical and radiological data were compared, and univariate and multivariate regression analyses identified independent risk factors for PK. A nomogram was then developed to predict the risk factors for PK after PKP.

Results: Of 129 patients, 47 (36.4%) experienced PK after PKP. Multivariate analysis identified independent risk factors for PK as preoperative kyphosis angle (OR = 1.26, P = 0.008), Type D magnetic resonance image (MRI) signal change on T2-weighted images (T2WI) (OR = 18.49, P = 0.003), black line signal (OR = 44.00, P < 0.001), intervertebral disc endplate complex (IDEC) injury (OR = 7.86, P = 0.021), and postoperative Oswestry Disability Index (ODI) score (OR = 1.18, P = 0.004). The nomogram, based on these factors, demonstrated strong discriminative performance (area under the curve = 0.953) and good calibration.

Conclusions: Preoperative kyphosis angle, Type D MRI signal change on T2WI, black line signal, IDEC injury, and higher postoperative ODI score are independent risk factors for PK after PKP. A nomogram based on these factors accurately predicts PK risk.