Segmental distribution and influencing factors of thoracolumbar osteoporotic vertebral compression fracture

Percutaneous vertebroplasty (PVP) is highly effective treatment for osteoporotic vertebral compression fractures (OVCF). There is no clear conclusion regarding the common locations of fractures, and whether recurrent fractures are related to surgery, or changes in local spinal alignment.

A total of 164 patients with thoracolumbar OVCF from June 2020 to June 2024 were enrolled. The segmental distribution with initial and recurrent fractures were collected. The impact of surgery on recurrent fractures was analyzed by comparing the segmental distribution of recurrent fractures between groups. 84 patients with T11-L2 OVCF were divided into two groups based on recurrent fractures or not. The gender, age, trauma of patients were measured, imaging indicators including bone cement distribution type, T11-L2 Cobb angle, Cobb angle and height recovery rate of fractured vertebra, and vertebral CT value were measured at the time of initial fracture, immediately after surgery, and recurrent fracture. The influencing factors of recurrent OVCF were explored through inter-group comparative analysis.

Both initial and recurrent fractures mostly occurred in the T11-L3, accounting for 80.4% and 63.1%, respectively. In the non-surgical group, the recurrent fractures were found mostly at L1 and L2 levels, accounting for 21.6%; while in the surgical group, the fractures occurred mostly at L1 level, accounting for 14.0%. In 84 patients with T11-L2 OVCF, among surgical patients, average age in the recurrent fracture group was 8.4 years older(P<0.001), and the average CT value was 22.9 HU lower (P =0.012) than that in the non-recurrent group. For each 1-year increase in age, the risk of recurrent fractures increased by 7.1%; for each 1 HU decrease in CT value, the risk of recurrent fractures increased by 2.1%. In addition, 78.6% of patients with initial fractures had a history of trauma, and 64.7% of patients with recurrent fractures had a history of trauma.

Initial and recurrent OVCF of the thoracolumbar spine commonly occurred in T11 to L3 segments. The segment of initial fracture and surgical treatment were not associated with recurrent fracture location or risk. Advanced age and decreased CT value are risk factors for recurrent fractures. The occurrence of the fracture, mostly depends on the presence of trauma. REGISTRY: www.chictr.org.cn, TRN: ChiCTR2500105987, Registration date: 27 June 2025.