Abstract: BACKGROUND: In recent years, vertebral augmentation surgery has a good effect on osteoporotic vertebral fracture, but with the increasing number of cases, we have found that some patients still complain of obvious pain after receiving vertebral augmentation surgery.
OBJECTIVE: To analyze the multiple factors that affect the poor efficacy after vertebral augmentation surgery of acute symptomatic thoracolumbar osteoporotic compression fracture, and to conduct a multivariate logistic regression analysis of related factors.
METHODS: The data of 850 patients who were treated with primary vertebral augmentation in the treatment of vertebral compression fractures in Honghui Hospital, Xi’an Jiaotong University from July 2016 to May 2019 were retrospectively analyzed. According to the visual analogue scale score of low back pain within one month after operation, the curative effect was judged by the score, in which ≥ 4 points were regarded as poor curative effect. A total of 61 patients had poor curative effect (poor curative effect group). The random number table method was used to select 61 patients from 789 patients with satisfactory curative effect as the satisfactory group. The gender, age, body mass index, preoperative bone mineral density T value, operative segment, operation time, surgical path, degree of fracture compression, bone cement injection volume, postoperative bone cement leakage, type of bone cement leakage, postoperative adjacent segment fracture, soft tissue injury, and postoperative bone cement distribution were investigated in both groups. Univariate and multivariate logistic regression analysis was used to explore the risk factors of poor efficacy. This study was approved by the Ethics Committee of Honghui Hospital, Xi’an Jiaotong University (approval No. 202005005). 
RESULTS AND CONCLUSION: (1) There was no significant difference between the two groups of patients in terms of age, gender, operation time, surgical path, the degree of compression fracture, and injured vertebral segment (P > 0.05). There were statistically significant differences in bone cement leakage, adjacent segment fractures, soft tissue injury, bone cement distribution, bone mineral density T value, and bone cement injection volume (P < 0.05). (2) Binary Logistic regression analysis showed that the poor efficacy of vertebral body enhancement after surgery was significantly correlated with bone cement leakage, adjacent segment fractures, soft tissue injury, bone cement distribution, and bone mineral density T value (P < 0.05). (3) The results of ROC analysis showed that bone mineral density T predicted that the AUC of the poor efficacy after vertebral augmentation was 0.809 (β=0.040, 95%CI=0.729-0.888, P=0.000); the best cut-off value was -3.05; the sensitivity and specificity were 0.721 and 0.836, respectively. (4) These results indicate that bone cement distribution, bone cement leakage, adjacent segment fracture, soft tissue injury, and bone mineral density T value are the risk factors for the poor efficacy after vertebral augmentation in patients with acute symptomatic osteoporotic thoracolumbar vertebral compression fracture.

Key words: bone, materials, bone cement, vertebral augmentation, osteoporosis, vertebral fracture, postoperative pain, risk factors, tissue engineering