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Published on: October 17, 2019
Prediction of progressive local kyphosis following PVP/PKP for osteoporotic vertebral fractures based on the OF
JiaDong Wang1,2, Pan Fan1,2, Lei Liu1,2
1Southeast University, Nanjing, China.
Purpose:
The aim of this study was to identify risk factors for progressive local kyphosis (PLK) following percutaneous vertebroplasty/kyphoplasty (PVP/PKP) in patients with osteoporotic vertebral fracture (OVF) and to develop a predictive model based on the osteoporotic fracture (OF) classification, integrating baseline characteristics, imaging parameters, and surgical factors. This model aims to preoperatively identify high-risk patients for PLK and to optimize perioperative surgical decision-making.
Methods:
This retrospective cohort study included 374 OVF patients who underwent single-level PVP/PKP with a ≥ 2-year follow-up. Patients were randomly divided into a derivation cohort (n = 267) and a validation cohort (n = 107). Multidimensional data, including demographics, bone mineral density, comorbidities, imaging parameters (local kyphotic angle [LKA], vertebral compression ratio, OF classification, and endplate integrity), surgical details (cement volume/distribution), and clinical outcomes (visual analog scale [VAS]/Oswestry Disability Index [ODI]), were collected. PLK was defined as a ≥ 10° increase in the LKA at the final follow-up compared with that on postoperative Day 1. Predictors were identified using random forest, least absolute shrinkage and selection operator (LASSO) regression, and decision tree analyses. A risk scoring system was developed via logistic regression and validated using receiver operating characteristic (ROC) curves, Hosmer-Lemeshow tests, calibration curves, and decision curve analysis (DCA).
Results:
Among 267 patients in the derivation cohort, 43 (16.1%) developed PLK. Compared with the non-PLK group, the PLK group had significantly greater vertebral height loss and worse final VAS/ODI scores. The key predictors identified included the reclassified OF system (Type I, II, and III), the presence of an intravertebral cleft, the presence of cardiac disease, and the overcorrection of the LKA (> 4.5° intraoperatively). A 9-point risk score was established (AUC = 0.915; cutoff = 2.5), with a sensitivity of 57.8% and specificity of 85.3%. Validation cohort analysis confirmed robust performance (AUC = 0.881). DCA demonstrated superior clinical net benefit within a threshold probability of 10-50%.
Conclusions:
In this study, a predictive scoring system integrating the OF classification, imaging features, and surgical factors was developed to identify OVF patients at high risk for PLK. A total score > 2.5 serves as a clinical decision-support threshold, suggesting that these patients may benefit from a multidisciplinary evaluation for alternative stabilization strategies or intensified postoperative surveillance, tailored to clinical judgment and individualized patient factors.
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