Review on the etiology and risk factors of progressive local kyphosis after vertebral augmentation for osteoporotic vertebral fractures
10.3760/cma.j.cn121113-20240422-00235
- VernacularTitle:骨质疏松性椎体骨折椎体强化术后进展性局部后凸的研究进展
- Author:
Jiadong WANG
1
;
Lei LIU
;
Yuzhu XU
;
Pan FAN
;
Lele ZHANG
;
Wenwu GAN
;
Feng ZHANG
;
Yuntao WANG
Author Information
1. 东南大学医学院，南京 210009
- Keywords:
Vertebral body;
Osteoporotic fractures;
Vertebroplasty;
Kyphoplasty;
Kyphosis;
Risk factors;
Forecasting
- From:
Chinese Journal of Orthopaedics
2024;44(21):1424-1431
- CountryChina
- Language:Chinese
-
Abstract:
With an aging population, the incidence of osteoporotic vertebral fractures (OVFs) is on the rise, posing new challenges for developing personalized treatment strategies. For patients who do not respond to conservative treatment, percutaneous vertebroplasty or percutaneous kyphoplasty (PVP/PKP) remains the preferred surgical option due to its minimal invasiveness and rapid recovery time. However, progressive local kyphosis (PLK) is one of the most severe complications following PVP/PKP, with an incidence rate of 1.5%-25.8%. PLK often presents with recurring thoracic and lower back pain, and in severe cases, spinal stenosis, causing symptoms like numbness and pain in the lower limbs. The severity of PLK varies, and treatments can range from conservative management and bone cement reinforcement to internal fixation or osteotomy. Current studies suggest that re-fracture of the affected vertebra, intervertebral disc degeneration, and osteonecrosis may be underlying mechanisms. These conditions shift the axial load forward, promoting postoperative PLK, which tends to progress over time. Postoperative PLK is closely associated with patient characteristics, fracture details, surgical factors, and post-surgery osteoporosis management. 1) The severity of osteoporosis, as indicated by the T-score from bone mineral density testing, can help predict postoperative PLK. While factors like age and gender influence osteoporosis severity, no direct relationship has been established between these factors and PLK. 2) Thoracolumbar fractures, old nonunion fractures, endplate fractures, or severe preoperative compression changes with kyphosis can increase PLK risk. Surgical factors, including the use of balloons or implants and the distribution of bone cement, also play a role. Personalized treatment plans should be developed based on the patient's general condition and imaging results to ensure adequate bone cement diffusion, as enhanced integration can reduce PLK risk. 3) Postoperative anti-osteoporosis therapy is also crucial; long-term therapy, particularly with teriparatide, can prevent PLK. Recognizing the related risk factors and establishing predictive models can help clinicians tailor treatments. Machine learning models, utilizing big data, are particularly adept at handling complex interrelated risk factors and may provide a powerful tool for personalized treatment in the future.
