Development and validation of a prediction model for new vertebral fracture after percutaneous kyphoplasty

Percutaneous kyphoplasty (PKP) is one of the primary treatment options for osteoporotic vertebral compression fractures (OVCF). New vertebral compression fractures (NVCF) are common complications following PKP. This study aims to identify risk factors associated with NVCF after PKP and to develop a simple and user-friendly predictive model to assist clinicians in decision-making. A retrospective cohort study was conducted, analyzing clinical data from 340 patients with single-segment OVCF who underwent PKP at our institution between January 2020 and December 2022. We collected general clinical data and imaging findings from patients who underwent PKP at our institution. Lasso regression was employed to identify risk factors for NVCF after PKP, and the selected variables were further analyzed using an unrestricted cubic spline function. Finally, a predictive model was established using multivariate logistic regression analysis. The variables selected by Lasso regression included pre-op AVH (OR = 0.853) and vertebral height restoration rate (OR = 4.318). Restricted cubic spline function analysis demonstrated that patients with a pre-op AVH of less than 19.2 mm had a significantly increased risk of NVCF after PKP. Pre-op AVH and anterior vertebral height restoration rate are independent risk factors for NVCF after PKP. The predictive model constructed based on these two independent risk factors can effectively assess the risk of NVCF in elderly patients with OVCF undergoing PKP, providing valuable guidance for clinical decision-making.