A Novel Imaging-Based Scoring System to Predict Progressive Kyphosis and Residual Back Pain Post-Percutaneous Kyphoplasty in Osteoporotic Vertebral Compression Fractures

Abstract A novel imaging-based scoring system (NIBSS) was developed to assess osteoporotic vertebral compression fractures (OVCFs) and predict progressive kyphosis (PK) and residual back pain (RBP) post-Percutaneous Kyphoplasty (PKP). We conducted a single-center retrospective study involving 129 OVCF patients treated with PKP from January 2020 to December 2022. Patients were categorized into low-score and high-score groups based on NIBSS, revealing significantly lower Vertebral Height Loss (VHL), Kyphosis angle (KA), and VAS/ODI scores in the low-score group (P < 0.05). High-score patients showed increased risk of PK and RBP (OR = 11.323 and OR = 13.591, respectively, P < 0.001). Multivariate analysis identified independent risk factors for PK as NIBSS score, postoperative KA difference, black-liner signal, and postoperative ODI score. Additionally, independent risk factors for RBP were determined to be NIBSS score, postoperative KA, and Type D cement form. Our models exhibited strong discriminative performances (AUC = 0.923 and 0.894). NIBSS emerged as a pivotal predictor for adverse outcomes, advocating for tailored interventions in high-risk patients, such as rigid bracing, active osteoporosis treatment, or even adjunctive internal fixation. This study underscores the clinical utility of NIBSS in guiding treatment decisions and improving patient outcomes post-PKP.