Abstract: BACKGROUND: Distinct risk factors for new adjacent vertebral fractures following percutaneous vertebroplasty in the elderly patients with osteoporotic vertebral compression fractures and underlying diseases may be different, yet there is a scarcity of pertinent research on this topic.
OBJECTIVE: To investigate the high-risk factors for refracture in patients with osteoporotic vertebral compression fractures following percutaneous vertebroplasty and to delve deeper into the correlation between these risk factors and the recurrence of fractures in the operated vertebra as well as its adjacent vertebrae post-percutaneous vertebroplasty.
METHODS: According to the inclusion criteria, 412 patients with osteoporotic vertebral compression fractures who underwent percutaneous vertebroplasty at the Sixth Affiliated Hospital of Xinjiang Medical University between January 2018 and December 2023 were retrospectively screened. According to whether re-fracture occurred during the follow-up period, the patients were divided into a re-fracture group (n=75) and a non-re-fracture group (n=337). The following variables of the two groups of patients were reviewed: age, gender, body mass index, cement leakage, bone density T value, cement dosage, occupation, smoking, drinking, adverse reactions, medical insurance, hypertension, type 2 diabetes, chronic obstructive pulmonary disease, cerebral hemorrhage, coronary heart disease, psychological trauma, psychiatric treatment, osteoarthritis, gout, scoliosis, spinal surgery, chronic kidney, anti-osteoporosis treatment, previous fracture history (fracture caused by osteoporosis) and fracture injury plane. The above factors were analyzed using univariate analysis. The factors with P < 0.05 were subjected to binary logistic analysis to explore the related factors of postoperative vertebral recompression fracture.
RESULTS AND CONCLUSION: (1) Univariate analysis showed that after percutaneous vertebroplasty, vertebral refracture was associated with age, smoking history of > 10 years, cement leakage, hypertension, type 2 diabetes, scoliosis, spinal surgery, and chronic kidney disease, with statistically significant differences (P < 0.05). (2) By binary Logistic regression, bone cement leakage condition (OR=2.547, 95%CI:1.283-5.048, P < 0.05), smoking history > 10 years (OR=2.336, 95%CI:1.157-4.701, P < 0.05), a history of hypertension (OR=4.657, 95%CI:2.137-10.242, P < 0.05), a history of type 2 diabetes mellitus (OR=8.956, 95%CI:3.941-21.301, P < 0.05), and a medical history of scoliosis (OR=3.754, 95%CI:1.755-8.619, P < 0.05), medical history of spinal surgery (OR=2.700, 95%CI:1.058-6.725, P < 0.05), and a history of chronic kidney disease (OR=2.812, 95%CI:1.078-7.739, P < 0.05) were risk factors for refracture of the operated vertebral body and adjacent vertebrae. (3) The results showed that cement leakage, smoking for > 10 years, hypertension, type 2 diabetes mellitus, scoliosis, spinal surgery, and chronic kidney were risk factors for recurrent fractures of the operated vertebrae and adjacent vertebrae in patients with osteoporotic vertebral compression fractures. Surgeons should conduct a comprehensive assessment of patients before percutaneous vertebroplasty in order to more accurately predict the possibility of re-fracture and provide a basis for the formulation of personalized treatment plans to reduce the risk of future recurrent fractures. 

Key words: osteoporotic vertebral compression fracture, percutaneous vertebroplasty, vertebral recompression, refracture, risk factor, underlying disease