Risk factor analysis of adjacent vertebral compression fracture following the surgery of percutaneous kyphoplasty in postmenopausal women

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Methods Two hundred and ninety-seven postmenopausal female patients, underwent PKP surgery between January 2016 and December 2020, were divided into two groups according to whether or not AVCF. Receiver operating characteristic(ROC) curves were generated to analyze the sensitivity and specificity of the relative risk factors in the identification of AVCF. Results In this study of 297 postmenopausal women who underwent PKP, 67 developed AVCF during follow-up. There were no significant differences in BMI, surgical method, or cement leakage between the groups. The AVCF group was older, had lower BMD, less bone cement volume per section, higher VHA, and larger VKAC. The non-fracture group had lower postoperative VAS and fewer surgical vertebrae. The model showed good discrimination with age, BMD, postoperative VAS, VHR, and VKAC. ROC analysis indicated that a postoperative VAS score > 2.5 was highly predictive of AVCF in postmenopausal women after PKP. Conclusion Clinicians should pay particular attention to postoperative pain management in PKP patients, rather than forcing too much restoration of vertebral height and vertebral lordosis angle. osteoporotic vertebral compression fractures adjacent vertebral compression fracture risk factor percutaneous kyphoplasty postmenopausal women Figures Figure 1 Figure 2 Figure 3 Introduction Osteoporotic vertebral compression fractures (OVCFs) are becoming a common source of back pain and progressive spinal deformity, reducing quality of life and becoming an increasingly serious health problem worldwide ( 1 , 2 ). Percutaneous kyphoplasty (PKP) is widely used as a minimally invasive technique for treating OVCFs ( 3 ). However, the incidence of Adjacent Vertebral Compression Fracture (AVCF) after PKP is high, which seriously affects the curative effect of operation and the quality of life of patients ( 4 – 6 ). The postmenopausal women are more likely to have AVCF after PKP surgery than other populations ( 7 ), in clinical work. Why does such a clinical phenomenon occur? Age, operative vertebral body, Bone Mineral Density (BMD), cement volume, Vertebral height restoration (VHA), Vertebral kyphosis angle correction (VKAC) and the number of injured vertebrae were considered risk factors for AVCF after PKP surgery ( 8 – 10 ). Does this apply to postmenopausal women? This study aimed to identify the related risk factors of AVCF in postmenopausal women after PKP surgery. Methods Source of Data : A total of 297 patients who received PKP surgery between January 2016 and December 2020 were divided into two groups according to whether the adjacent vertebral body was fractured. We retrospectively reviewed the medical records and radiographic images from the Tongbu Yuanfang Smart Medical Integrated Information System and the Xinyi International Digital Medical Imaging System (Fig. 1 ). The study protocol was approved by the ethics committee of our Hospital (NO. K [2022] 007). Inclusion criteria : ( 1 ) Postmenopausal women meet the diagnostic criteria of osteoporotic vertebral fracture ( 11 ). ( 2 ) It has the indication of operation, and there is no obvious contraindication of operation before surgery. ( 3 ) MRI showed fresh fractures, and CT showed no obvious signs of rupture of the posterior wall of the vertebral body. ( 4 ) All cases were treated with PKP for the first time. ( 5 ) All patients had informed consent and voluntarily participated in this study. Exclusion criteria : ( 1 ) Thoracolumbar burst fracture, bone tumor, spinal metastatic tumor, vertebral body and paraspinal infection. ( 2 ) The patients do not cooperate with each other due to various factors and the follow-up data are not available. ( 3 ) Combination of other types of osteoporosis or diseases affecting bone mineral metabolism. ( 4 ) With smoking history. Surgical methods : The patient took the prone position and put a special cushion on the abdomen to make the thoracolumbar vertebrae in the state of back extension. Under the perspective of the perspective machine, the fracture vertebral body was clearly identified and marked, and the skin was disinfected with routine iodophor solution and covered with operation towels ( 12 , 13 ). The periosteum of vertebral arch was anesthetized layer by layer with 1% lidocaine injection. All patients were routinely treated with kyphoplasty (PKP). After the operation, the patients were resting in supine position for 24 hours, and routine anti-osteoporosis treatment such as calcium and calcitriol capsule were given after operation ( 14 ). X-rays were performed on the third day after surgery. Follow-up was at 1, 3, 6, and 12 months after surgery and at 1-year intervals thereafter. Lumbar X-rays were taken at each interval of follow-up and CT and MRI were performed if necessary. Patients : A typical case: A 70-year-old woman (weight = 67.5kg, height = 157.0cm, T-score=-3.2) was hospitalized with "sudden onset of low back pain after bending over with limited mobility for 1 week", who had a history of hypertension and rheumatic immune disease (long-term oral methylprednisolone tablets 2.5 mg/day). Imaging data suggested L1 vertebral body fracture (Fig. 2 a-d). Then L1 PKP had been performed, and the intraoperative pathology showed bone, bone marrow, and dead bone fragments, with hemorrhage and degeneration at localized foci (Fig. 2 k, l). Postoperative bone cement dispersed well (Fig. 2 e, f, m). The preoperative low back pain VAS was 9, 5 on the second day postoperatively and 3 when discharge. Six months after surgery, the patient (weight = 67.5kg, height = 157.0cm, T-score =-2.6) was readmitted to the hospital with "sudden onset of low back pain with limitation of movement for 1 day", and the imaging showed an AVCF (L2) (Fig. 2 g-j). Postoperative bone cement dispersed well (Fig. 2 n). The preoperative low back pain VAS was 8. And it was 4 on the second day postoperatively and when discharge the VAS was 3. Patients were divided into two groups according to whether or not AVCF by the imaging results of postoperative follow-up. The data collected were as follows: age, BMD, the number of surgical vertebral body, the visual analogue scale (VAS) score of postoperative lower back, the surgical site (thoracic spine/lumbar spine), the surgical method (unilateral/bilateral), the single section of bone cement volume, the height and the kyphosis angle of the change before and after surgery (Fig. 2 b), the leakage of bone cement. Statistical method : SPSS 24.0 statistical software (SPSS, Inc., Chicago, IL) was used for analysis. Age, T-score in BMD, number of surgical vertebral body, the VAS scores after surgery, the surgical site (thoracic spine/lumbar spine), the surgical method (unilateral/bilateral), the single section of bone cement volume, the VHR after surgery, the VKAC after surgery, the leakage of bone cement were modified to categorical variables. T-test was used to compare the two groups of measurement data of normal distribution data. The constituent ratio was tested by χ 2 test, and the non-normal distribution data were tested by non-parametric test. Fisher exact test was performed for categorical variables. Multivariate Logistic stepwise univariate regression analysis was used to screen the related factors. Odds ratios (ORs) for each condition of progressive re-collapse and their 95% confidence intervals (CI) were calculated by multiple logistic regression test and backward selection. A P < 0.05 was considered statistically significant. Results A total of 297 patients who received PKP surgery between January 2016 and December 2020 were included in clinical retrospective studies. The follow-up period was a mean of 2.1 ± 0.4 years (range,2–3years). According to the follow-up results, the patients were divided into two groups according to whether the adjacent vertebral body was fractured: the fracture group and the non-fracture group. A total of 67 patients had AVCF after PKP in postmenopausal women. The probability of re-fracture after PKP was 22.56%. Of the 67 patients (average age 68.21 ± 5.47 years old) who met the criteria, including 4 cases (5.97%) at thoracic spine, 63 cases (94.03%) at lumbar spine. Univariate analysis of fractures in the adjacent vertebral body after PKP Among patients between the fracture group and the non-fracture group, one-way analysis of variance showed that there was no significant difference in the surgical method (unilateral/bilateral) ( p = 0.513) and the leakage of bone cement( p = 0.062). However, one-way analysis of variance demonstrated significant differences between the groups when comparing in the age( p = 0.001), the bone mineral density (BMD)( p = 0.000), the number of surgical vertebral body( p = 0.014), the VAS scores after surgery( p = 0.000), the surgical site (thoracic spine/lumbar spine)( p = 0.001), the single section of bone cement volume( p = 0.034), the VHR after surgery( p = 0.000) and the VKAC after operation ( p = 0.000), as shown in Table 1 . Table 1 Univariate analysis of fractures in the adjacent vertebral body after PKP (mean ± SD) Variables Fracture(n = 67) Non-fracture(n = 230) t/χ 2 P Age(years) 68.21 ± 5.47 62.63 ± 5.36 3.449 0.001 * BMD(T-score) -2.50 ± 1.01 -1.96 ± 1.04 2.008 0.000 * BMI (kg/m 2 ) 23.18 ± 2.74 22.46 ± 2.61 1.097 0.429 Surgical method (bilateral\ unilateral) 53\14 190\40 0.428 0.513 VAS scores after surgery 3.60 ± 1.01 1.94 ± 0.49 15.707 0.000 * Number of surgical vertebral body (1\≥2) 28\39 135\95 5.988 0.014* Surgical site (lumbar\ thoracic) 63\4 172\58 11.637 0.001 * Leakage of bone cement(Y/N) 41/26 68/162 3.494 0.062 Single section of bone cement volume 3.39 ± 0.65 5.52 ± 0.96 2.140 0.034 * Vertebral height restoration(mm) 2.32 ± 0.43 1.50 ± 0.31 -22.014 0.000 * Vertebral kyphosis angle correction (°) 10.01 ± 1.15 7.44 ± 1.49 -16.043 0.000 * Notes: P< 0.05 compared to the preoperative baseline values. Quantitative variables are expressed as mean ± SD. Abbreviations: SD, standard deviation; BMD, bone mineral density; BMI, body mass index; VAS, visual analogue scale. Binary logistic regression analysis of AVCF following PKP surgery in postmenopausal women When these factors were incorporated into the binary logistic regression analysis, the results showed that the age( OR = 4.022, 95%CI 1.348–12.002, p = 0.013), the BMD( OR = 2.008, 95%CI 1.465–2.754, p = 0.000), the VAS scores after surgery ( OR = 1.472, 95%CI 1.135–1.909, p = 0.004), the VHR after surgery ( OR = 0.181, 95%CI 0.089–0.367, p = 0.000) and the VKAC after operation( OR = 0.806, 95%CI 0.689–0.943, p = 0.007) were correlated with adjacent vertebral fractures following PKP surgery in postmenopausal women, as show in Table 2 . Table 2 Prediction factors for AVCFs after PKP surgery in postmenopausal women Variables OR 95% CI p- value Age(years) 4.022 1.348–12.002 0.013* BMD(T-score) 2.008 1.465–2.754 0.000* VAS scores after surgery 1.472 1.135–1.909 0.004* Vertebral height restoration(mm) 0.181 0.089–0.367 0.000* Vertebral kyphosis angle correction (°) 0.806 0.689–0.943 0.007* Notes: P< 0.05 compared to the preoperative baseline values. Abbreviations: BMD, bone mineral density; VAS, visual analogue scale; CI, confidence interval; OR, odds ratio. ROC curve analysis of AVCF following PKP surgery in postmenopausal women Multivariate analysis found that the Age, the BMD, the VAS scores after surgery, the VHR after surgery and the VKAC after operation were independent risk factors for AVCF in postmenopausal women after PKP surgery. Incorporate statistically significant measurement indicators in patient clinical data into the ROC curve analysis, the results showed that the area under ROC curve for Age was 0.536(sensitivity 23.48%, specificity 91.04%, cut-off value = 68.5 years), the area under ROC curve for BMD was 0.522(sensitivity 73.48%, specificity 31.34%, cut-off value=-3.25), the area under ROC curve for VAS was 0.899(sensitivity 90.87%, specificity 80.60%, cut-off value = 2.5), the area under ROC curve for VHR was0.628 (sensitivity 31.74%, specificity 88.06%, cut-off value = 1.8mm) and the area under ROC curve for VKAC was 0.622 (sensitivity 24.35%, specificity 100%, cut-off value = 8.5°)(Fig. 3 ) This approach enabled the assessment of this risk factors for its predictive potential in postmenopausal women after PKP surgery. Discussion Postmenopausal women have hormone secretion disorders in their bodies, which often lead to fragile or even severe bone quality, and in severe cases lead to OVCFs) ( 15 , 16 ). PKP is a minimally invasive technique for treating painful OVCFs ( 17 ). A large number of high-quality studies have shown that the effective relief rate of postoperative pain of PKP can reach more than 80%( 18 ). However, with the increasing numbers of PKP surgery in clinical, operation complications such as insufficient postoperative pain relief, leakage of bone cement, and re-collapse of the vertebral body and AVCF were attention by more and more people. Which has led to a decline in the quality of life of patients and an increase in the difficulty of treatment. Unfortunately, to the best of our knowledge, no critical factors have been clearly described the specific mechanism of AVCF in postmenopausal women after PKP. Consistent with previous studies ( 19 , 20 ), our study found that AVCF is a common complication after surgery. In this study, we followed up with postmenopausal women who underwent PKP and observed that the incidence of AVCF in this population was as high as 22.56% in the three years following surgery, which aligns with findings from previous studies ( 21 , 22 ). In previous studies, age and osteoporosis have been found to be risk factors for adjacent vertebral fractures ( 23 – 25 ). Our findings show that this pattern also applies to postmenopausal women. The number of surgical vertebral bodies is probably not a risk factor for the development of AVCF. In our study, by univariate analysis, we found that the number of surgical vertebral body of the fracture group was significantly more than that of the non-fracture group( p = 0.014). However, when we included the number of surgical vertebral body in multivariate analysis, the results showed no correlation between the number of surgical vertebral body and adjacent vertebral fractures. One-way analysis of variance showed that incidence of the surgical site (thoracic spine/lumbar spine) ( p = 0.001) and the single section of bone cement volume( p = 0.034) were significantly greater in the fracture group than in the non-fracture group; however, further binary logistic regression analysis showed no significant correlation between the two groups. In our study, VAS scores after surgery, VHR and VKAC were important risk factors. We believe that postoperative VAS scores were significantly higher in the fracture group than in the non-fracture group, especially when the postoperative VAS is still > 2.5, making patients more inclined to bed rest and less exercise, and therefore more prone to accelerated bone loss ( 26 – 28 ), in addition to the fact that this behavior is not conducive to postoperative reconstruction of vertebral mechanics. Finally, the risk of developing AVCF is increased. At the same time, the VHR after surgery or the VKAC after operation in the fracture group were greater than those in the non-fracture group. This result was also consistent with previous opinion reported by previous studies ( 29 – 31 ). We conjecture that VHR and VKAC result in increased shear forces in adjacent segments, leading to an increased risk of compression fracture of adjacent vertebrae. Subject to this study, postoperative pain improvement was closely associated with the incidence of AVCF and we do not recommend for force the perfect recovery of vertebral height and Vertebral kyphosis angle in the operation. First, our study indicates that the incidence of adjacent vertebral fracture is too high. Second, it may increase the risk of bone cement leakage and patient medical bills. Other risk factors were found no significant association with AVCF in our study. Limitation Our study has several limitations. A major limitation of this study was that the number of cases was not large. Our efforts resulted in well-selected but small patient groups, and the case data are from the same medical institution and are retrospective in nature. Additionally, all cases were from a single center, so it remains necessary to perform large-sample multicenter prospective studies in the future. Another limitation was the inconsistency of last follow-up period for every subject in our study, wildly ranging from 24 to 36 months. What’s more, many potential AVCF risk factors were not included in this study for example: nutritional deficiencies, vitamin D, calcium, whether anti-osteoporotic treatment etc. Finally, limitation was that this study only analyzed objective quantitative indicators, and did not evaluate the influence and role of subjective emotional factors. In future studies, a prospective, multi-center trial should be performed together with finite element analysis in order to study and validate the relevant risk factors. Conclusion Our results indicate that in postmenopausal women undergoing PKP surgery, there is a correlation between AVCF and age, BMD, VAS scores after surgery, VHR and VKAC. VHR and VKAC are reliable predictors of the risk of adjacent vertebral compression fractures (AVCF) in postmenopausal women. VAS scores higher than 2.5 after surgery can be considered an important risk factor for the development of AVCF. These identified risk factors may lead to varying degrees of dysfunction in patients, emphasizing the need for careful observation and follow-up to prevent worsening of their clinical condition. Therefore, clinicians should give special attention to postoperative pain management in PKP patients, rather than forcing too much restoration of vertebral height and vertebral lordosis angle. Declarations Funding and Disclosures The project was generously supported by the grants from Projects of Traditional Chinese Medicine of Hubei Provincial Administration of Traditional Chinese Medicine (ZY2023M013 and ZY2021M034), Science and Technology Bureau Science and Technology Projects of Ezhou (EZ01-007-20230127). The funding institutions had not any role in the study design, data collection, data analysis, interpretation, or writing of the report in this study. Author Contribution All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Fan Wu, Xingda Chen, Jingjing Tang and Rueishiuan Jiang. The first draft of the manuscript was written by Fan Wu, Xingda Chen and Jingjing Tang, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript Ethics Approval and Consent to Participate This study has been reviewed by the appropriate ethics committee of Hubei Provincial Hospital of Integrated Chinese and Western Medicine (NO. K [2022] 007). and have been performed in accordance with the ethical standards laid down in an appropriate version of the 1964 Declaration of Helsinki, all persons gave their informed consent prior to their inclusion in the study. Conflict of Interest Fan Wu, Xingda Chen and Jingjing Tang declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Data availability The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request. Informed consent Informed consent was obtained from all individual participants included in the study. References Patel D, Liu J, Ebraheim NA. Managements of osteoporotic vertebral compression fractures: A narrative review[J]. World Journal of Orthopedics , 2022, 13(6): 564. Donnally III CJ, DiPompeo CM, Varacallo M. Vertebral compression fractures [M]/ StatPearls [Internet] . StatPearls Publishing, 2022. Ning L, Zhu J, Shen T, et al. Correlation analysis between basic diseases and subsequent vertebral fractures after percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fractures[J]. 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Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 17 Feb, 2025 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 17 Sep, 2024 Reviews received at journal 11 Sep, 2024 Reviewers agreed at journal 27 Aug, 2024 Reviews received at journal 08 Aug, 2024 Reviewers agreed at journal 04 Aug, 2024 Reviews received at journal 12 Jul, 2024 Reviewers agreed at journal 27 Jun, 2024 Reviewers invited by journal 06 Jun, 2024 Editor assigned by journal 06 Jun, 2024 Editor invited by journal 30 May, 2024 Submission checks completed at journal 28 May, 2024 First submitted to journal 26 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4480156","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":311983273,"identity":"fd394cd1-8bc1-4a94-80a6-a146330fe918","order_by":0,"name":"Fan Wu","email":"","orcid":"","institution":"Geriatric Hospital Affiliated of Wuhan University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Fan","middleName":"","lastName":"Wu","suffix":""},{"id":311983274,"identity":"3eac2907-bcbb-4802-9a4e-63383e8a6332","order_by":1,"name":"Xingda Chen","email":"","orcid":"","institution":"The First Clinical Medical College, Guangzhou University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Xingda","middleName":"","lastName":"Chen","suffix":""},{"id":311983275,"identity":"7cfe4b49-185c-48fe-afa5-581b560e2c02","order_by":2,"name":"Rueishiuan Jiang","email":"","orcid":"","institution":"The First Clinical Medical College, Guangzhou University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Rueishiuan","middleName":"","lastName":"Jiang","suffix":""},{"id":311983276,"identity":"ab14f7c1-8c43-4506-8649-4dcf9f3aab0a","order_by":3,"name":"Liqun Li","email":"","orcid":"","institution":"Geriatric Hospital Affiliated of Wuhan University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Liqun","middleName":"","lastName":"Li","suffix":""},{"id":311983277,"identity":"e048e2f5-b9d5-47bd-a913-2eccdd317f54","order_by":4,"name":"Lei Qin","email":"","orcid":"","institution":"Geriatric Hospital Affiliated of Wuhan University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Lei","middleName":"","lastName":"Qin","suffix":""},{"id":311983278,"identity":"bbed03df-9e43-4e43-b049-7f523e92b671","order_by":5,"name":"Weizhen Qi","email":"","orcid":"","institution":"Geriatric Hospital Affiliated of Wuhan University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Weizhen","middleName":"","lastName":"Qi","suffix":""},{"id":311983279,"identity":"6c5c3278-6e1d-437e-aa08-7774298a8a98","order_by":6,"name":"Chizi Hao","email":"","orcid":"","institution":"Zhongnan Hospital of Wuhan University","correspondingAuthor":false,"prefix":"","firstName":"Chizi","middleName":"","lastName":"Hao","suffix":""},{"id":311983280,"identity":"6d58c81d-631f-4863-a145-567e807d4fef","order_by":7,"name":"Jingjing Tang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1UlEQVRIiWNgGAWjYFACxgYGBjYQdfgAQwIpWiQYG44lEKsFBIBaGBh4DIhTLD+7ue3Bh7J7dcyNZz5/eLjDjoG/vRu/ZQZ3DrYbzjhXDHTY2W0SiWeSGSTOnN2AX4tEYps0b1sCWAtDYhszUCQXvxb5GUAtf8Fazjz+kNhWT1gLww2gFkaIFgagjYcJawH6pU2y51yCZGPDMTOgluM8BP0iP7v9mcSPsgR+wxmHH3/82VYtx9/eS8BhElDacMYBMM2DXzmyFnn+BsKKR8EoGAWjYGQCAL39TDxugNBEAAAAAElFTkSuQmCC","orcid":"","institution":"The First Affiliated Hospital of Guangzhou University of Chinese Medicine","correspondingAuthor":true,"prefix":"","firstName":"Jingjing","middleName":"","lastName":"Tang","suffix":""}],"badges":[],"createdAt":"2024-05-26 13:12:27","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4480156/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4480156/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-025-85381-9","type":"published","date":"2025-02-17T15:57:23+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":58230243,"identity":"1b8917df-8e4f-44d1-9cc4-9a10bc1a6ac7","added_by":"auto","created_at":"2024-06-12 19:18:37","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":274734,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlowchart of participants and measurements during the study period.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-4480156/v1/f514a09a9e1b12c7e6d5f4c1.png"},{"id":58230246,"identity":"cebc32e5-1c2c-4f95-81aa-2cd51f0f8084","added_by":"auto","created_at":"2024-06-12 19:18:37","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1450234,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMeasurement methods and typical cases.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e∠α= Vertebral kyphosis angle, (h1+h2+h3)/3= Vertebral height.\u003c/p\u003e\n\u003cp\u003ePreoperative Images (a-d). Intraoperative pathology (k, l). Postoperative Images(e, f, m). Postoperative 6-month images (g-j). L2 postoperative Images (n).\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-4480156/v1/9a89dd3e8a797610bc546046.png"},{"id":58230245,"identity":"f736ac60-5b56-4753-bd9d-448f00d38904","added_by":"auto","created_at":"2024-06-12 19:18:37","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":43419,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eROC curve of AVCF in patients with postmenopausal women after PKP surgery.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviations: \u003c/strong\u003eBMD, bone mineral density. VAS, visual analogue scale. VHR, vertebral height restoration. VKAC=vertebral kyphosis angle correction.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-4480156/v1/8c52efe71ae30406054547fb.png"},{"id":77052751,"identity":"674e8845-9487-4763-80b4-855094524e6f","added_by":"auto","created_at":"2025-02-24 16:24:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3401966,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4480156/v1/6ed0b48f-ed7d-4ada-b27a-3753ca81502e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Risk factor analysis of adjacent vertebral compression fracture following the surgery of percutaneous kyphoplasty in postmenopausal women","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOsteoporotic vertebral compression fractures (OVCFs) are becoming a common source of back pain and progressive spinal deformity, reducing quality of life and becoming an increasingly serious health problem worldwide (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Percutaneous kyphoplasty (PKP) is widely used as a minimally invasive technique for treating OVCFs (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). However, the incidence of Adjacent Vertebral Compression Fracture (AVCF) after PKP is high, which seriously affects the curative effect of operation and the quality of life of patients (\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The postmenopausal women are more likely to have AVCF after PKP surgery than other populations (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), in clinical work.\u003c/p\u003e \u003cp\u003eWhy does such a clinical phenomenon occur? Age, operative vertebral body, Bone Mineral Density (BMD), cement volume, Vertebral height restoration (VHA), Vertebral kyphosis angle correction (VKAC) and the number of injured vertebrae were considered risk factors for AVCF after PKP surgery (\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Does this apply to postmenopausal women? This study aimed to identify the related risk factors of AVCF in postmenopausal women after PKP surgery.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cb\u003eSource of Data\u003c/b\u003e: A total of 297 patients who received PKP surgery between January 2016 and December 2020 were divided into two groups according to whether the adjacent vertebral body was fractured. We retrospectively reviewed the medical records and radiographic images from the Tongbu Yuanfang Smart Medical Integrated Information System and the Xinyi International Digital Medical Imaging System (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The study protocol was approved by the ethics committee of our Hospital (NO. K [2022] 007).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eInclusion criteria\u003c/b\u003e: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) Postmenopausal women meet the diagnostic criteria of osteoporotic vertebral fracture (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) It has the indication of operation, and there is no obvious contraindication of operation before surgery. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) MRI showed fresh fractures, and CT showed no obvious signs of rupture of the posterior wall of the vertebral body. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) All cases were treated with PKP for the first time. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) All patients had informed consent and voluntarily participated in this study.\u003c/p\u003e \u003cp\u003e \u003cb\u003eExclusion criteria\u003c/b\u003e: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) Thoracolumbar burst fracture, bone tumor, spinal metastatic tumor, vertebral body and paraspinal infection. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) The patients do not cooperate with each other due to various factors and the follow-up data are not available. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) Combination of other types of osteoporosis or diseases affecting bone mineral metabolism. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) With smoking history.\u003c/p\u003e \u003cp\u003e \u003cb\u003eSurgical methods\u003c/b\u003e: The patient took the prone position and put a special cushion on the abdomen to make the thoracolumbar vertebrae in the state of back extension. Under the perspective of the perspective machine, the fracture vertebral body was clearly identified and marked, and the skin was disinfected with routine iodophor solution and covered with operation towels (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). The periosteum of vertebral arch was anesthetized layer by layer with 1% lidocaine injection. All patients were routinely treated with kyphoplasty (PKP). After the operation, the patients were resting in supine position for 24 hours, and routine anti-osteoporosis treatment such as calcium and calcitriol capsule were given after operation (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eX-rays were performed on the third day after surgery. Follow-up was at 1, 3, 6, and 12 months after surgery and at 1-year intervals thereafter. Lumbar X-rays were taken at each interval of follow-up and CT and MRI were performed if necessary.\u003c/p\u003e \u003cp\u003e \u003cb\u003ePatients\u003c/b\u003e: A typical case: A 70-year-old woman (weight\u0026thinsp;=\u0026thinsp;67.5kg, height\u0026thinsp;=\u0026thinsp;157.0cm, T-score=-3.2) was hospitalized with \"sudden onset of low back pain after bending over with limited mobility for 1 week\", who had a history of hypertension and rheumatic immune disease (long-term oral methylprednisolone tablets 2.5 mg/day). Imaging data suggested L1 vertebral body fracture (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003ea-d). Then L1 PKP had been performed, and the intraoperative pathology showed bone, bone marrow, and dead bone fragments, with hemorrhage and degeneration at localized foci (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003ek, l). Postoperative bone cement dispersed well (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003ee, f, m). The preoperative low back pain VAS was 9, 5 on the second day postoperatively and 3 when discharge. Six months after surgery, the patient (weight\u0026thinsp;=\u0026thinsp;67.5kg, height\u0026thinsp;=\u0026thinsp;157.0cm, T-score =-2.6) was readmitted to the hospital with \"sudden onset of low back pain with limitation of movement for 1 day\", and the imaging showed an AVCF (L2) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eg-j). Postoperative bone cement dispersed well (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003en). The preoperative low back pain VAS was 8. And it was 4 on the second day postoperatively and when discharge the VAS was 3.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003ePatients were divided into two groups according to whether or not AVCF by the imaging results of postoperative follow-up. The data collected were as follows: age, BMD, the number of surgical vertebral body, the visual analogue scale (VAS) score of postoperative lower back, the surgical site (thoracic spine/lumbar spine), the surgical method (unilateral/bilateral), the single section of bone cement volume, the height and the kyphosis angle of the change before and after surgery (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eb), the leakage of bone cement.\u003c/p\u003e \u003cp\u003e \u003cb\u003eStatistical method\u003c/b\u003e: SPSS 24.0 statistical software (SPSS, Inc., Chicago, IL) was used for analysis. Age, T-score in BMD, number of surgical vertebral body, the VAS scores after surgery, the surgical site (thoracic spine/lumbar spine), the surgical method (unilateral/bilateral), the single section of bone cement volume, the VHR after surgery, the VKAC after surgery, the leakage of bone cement were modified to categorical variables. T-test was used to compare the two groups of measurement data of normal distribution data. The constituent ratio was tested by χ\u003csup\u003e2\u003c/sup\u003e test, and the non-normal distribution data were tested by non-parametric test. Fisher exact test was performed for categorical variables. Multivariate Logistic stepwise univariate regression analysis was used to screen the related factors. Odds ratios (ORs) for each condition of progressive re-collapse and their 95% confidence intervals (CI) were calculated by multiple logistic regression test and backward selection. A P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 297 patients who received PKP surgery between January 2016 and December 2020 were included in clinical retrospective studies. The follow-up period was a mean of 2.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4 years (range,2\u0026ndash;3years). According to the follow-up results, the patients were divided into two groups according to whether the adjacent vertebral body was fractured: the fracture group and the non-fracture group.\u003c/p\u003e\n\u003cp\u003eA total of 67 patients had AVCF after PKP in postmenopausal women. The probability of re-fracture after PKP was 22.56%. Of the 67 patients (average age 68.21\u0026thinsp;\u0026plusmn;\u0026thinsp;5.47 years old) who met the criteria, including 4 cases (5.97%) at thoracic spine, 63 cases (94.03%) at lumbar spine.\u003c/p\u003e\n\u003cdiv id=\"Sec4\"\u003e\n \u003ch2\u003eUnivariate analysis of fractures in the adjacent vertebral body after PKP\u003c/h2\u003e\n \u003cp\u003eAmong patients between the fracture group and the non-fracture group, one-way analysis of variance showed that there was no significant difference in the surgical method (unilateral/bilateral) (\u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.513) and the leakage of bone cement(\u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.062). However, one-way analysis of variance demonstrated significant differences between the groups when comparing in the age(\u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.001), the bone mineral density (BMD)(\u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.000), the number of surgical vertebral body(\u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.014), the VAS scores after surgery(\u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.000), the surgical site (thoracic spine/lumbar spine)(\u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.001), the single section of bone cement volume(\u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.034), the VHR after surgery(\u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.000) and the VKAC after operation (\u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.000), as shown in Table\u0026nbsp;\u003cspan\u003e1\u003c/span\u003e.\u003c/p\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 1\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eUnivariate analysis of fractures in the adjacent vertebral body after PKP (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFracture(n\u0026thinsp;=\u0026thinsp;67)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNon-fracture(n\u0026thinsp;=\u0026thinsp;230)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003et/\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge(years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68.21\u0026thinsp;\u0026plusmn;\u0026thinsp;5.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62.63\u0026thinsp;\u0026plusmn;\u0026thinsp;5.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.449\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.001\u003cstrong\u003e*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMD(T-score)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-2.50\u0026thinsp;\u0026plusmn;\u0026thinsp;1.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.96\u0026thinsp;\u0026plusmn;\u0026thinsp;1.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003cstrong\u003e*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.18\u0026thinsp;\u0026plusmn;\u0026thinsp;2.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.46\u0026thinsp;\u0026plusmn;\u0026thinsp;2.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.097\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.429\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSurgical method (bilateral\\ unilateral)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53\\14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e190\\40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.428\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.513\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVAS scores after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.60\u0026thinsp;\u0026plusmn;\u0026thinsp;1.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.94\u0026thinsp;\u0026plusmn;\u0026thinsp;0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15.707\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003cstrong\u003e*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNumber of surgical vertebral body (1\\\u0026ge;2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28\\39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e135\\95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.988\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.014*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSurgical site (lumbar\\ thoracic)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63\\4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e172\\58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11.637\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.001\u003cstrong\u003e*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLeakage of bone cement(Y/N)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41/26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68/162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.494\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.062\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle section of bone cement volume\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.39\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.034\u003cstrong\u003e*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVertebral height restoration(mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.32\u0026thinsp;\u0026plusmn;\u0026thinsp;0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-22.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003cstrong\u003e*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVertebral kyphosis angle correction (\u0026deg;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.01\u0026thinsp;\u0026plusmn;\u0026thinsp;1.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.44\u0026thinsp;\u0026plusmn;\u0026thinsp;1.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-16.043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003cstrong\u003e*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cstrong\u003eNotes:\u003c/strong\u003e \u003cem\u003eP\u0026lt;\u003c/em\u003e0.05 compared to the preoperative baseline values. Quantitative variables are expressed as mean \u0026plusmn; SD.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAbbreviations:\u003c/strong\u003e SD, standard deviation; BMD, bone mineral density; BMI, body mass index; VAS, visual analogue scale.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\"\u003e\n \u003ch2\u003eBinary logistic regression analysis of AVCF following PKP surgery in postmenopausal women\u003c/h2\u003e\n \u003cp\u003eWhen these factors were incorporated into the binary logistic regression analysis, the results showed that the age(\u003cem\u003eOR\u0026thinsp;=\u003c/em\u003e\u0026thinsp;4.022, \u003cem\u003e95%CI\u003c/em\u003e 1.348\u0026ndash;12.002, \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.013), the BMD(\u003cem\u003eOR\u0026thinsp;=\u003c/em\u003e\u0026thinsp;2.008, \u003cem\u003e95%CI\u003c/em\u003e 1.465\u0026ndash;2.754, \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.000), the VAS scores after surgery (\u003cem\u003eOR\u0026thinsp;=\u003c/em\u003e\u0026thinsp;1.472, \u003cem\u003e95%CI\u003c/em\u003e 1.135\u0026ndash;1.909, \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.004), the VHR after surgery (\u003cem\u003eOR\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.181, \u003cem\u003e95%CI\u003c/em\u003e 0.089\u0026ndash;0.367, \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.000) and the VKAC after operation(\u003cem\u003eOR\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.806, \u003cem\u003e95%CI\u003c/em\u003e 0.689\u0026ndash;0.943, \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.007) were correlated with adjacent vertebral fractures following PKP surgery in postmenopausal women, as show in Table\u0026nbsp;\u003cspan\u003e2\u003c/span\u003e.\u003c/p\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 2\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003ePrediction factors for AVCFs after PKP surgery in postmenopausal women\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep-\u003c/em\u003evalue\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge(years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.348\u0026ndash;12.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.013*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMD(T-score)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.465\u0026ndash;2.754\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVAS scores after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.472\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.135\u0026ndash;1.909\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.004*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVertebral height restoration(mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.181\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.089\u0026ndash;0.367\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVertebral kyphosis angle correction (\u0026deg;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.806\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.689\u0026ndash;0.943\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.007*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cstrong\u003eNotes:\u003c/strong\u003e \u003cem\u003eP\u0026lt;\u003c/em\u003e0.05 compared to the preoperative baseline values.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAbbreviations:\u003c/strong\u003e BMD, bone mineral density; VAS, visual analogue scale; CI, confidence interval; OR, odds ratio.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\"\u003e\n \u003ch2\u003eROC curve analysis of AVCF following PKP surgery in postmenopausal women\u003c/h2\u003e\n \u003cp\u003eMultivariate analysis found that the Age, the BMD, the VAS scores after surgery, the VHR after surgery and the VKAC after operation were independent risk factors for AVCF in postmenopausal women after PKP surgery. Incorporate statistically significant measurement indicators in patient clinical data into the ROC curve analysis, the results showed that the area under ROC curve for Age was 0.536(sensitivity 23.48%, specificity 91.04%, cut-off value\u0026thinsp;=\u0026thinsp;68.5 years), the area under ROC curve for BMD was 0.522(sensitivity 73.48%, specificity 31.34%, cut-off value=-3.25), the area under ROC curve for VAS was 0.899(sensitivity 90.87%, specificity 80.60%, cut-off value\u0026thinsp;=\u0026thinsp;2.5), the area under ROC curve for VHR was0.628 (sensitivity 31.74%, specificity 88.06%, cut-off value\u0026thinsp;=\u0026thinsp;1.8mm) and the area under ROC curve for VKAC was 0.622 (sensitivity 24.35%, specificity 100%, cut-off value\u0026thinsp;=\u0026thinsp;8.5\u0026deg;)(Fig.\u0026nbsp;\u003cspan\u003e3\u003c/span\u003e) This approach enabled the assessment of this risk factors for its predictive potential in postmenopausal women after PKP surgery.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003ePostmenopausal women have hormone secretion disorders in their bodies, which often lead to fragile or even severe bone quality, and in severe cases lead to OVCFs) (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). PKP is a minimally invasive technique for treating painful OVCFs (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). A large number of high-quality studies have shown that the effective relief rate of postoperative pain of PKP can reach more than 80%(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). However, with the increasing numbers of PKP surgery in clinical, operation complications such as insufficient postoperative pain relief, leakage of bone cement, and re-collapse of the vertebral body and AVCF were attention by more and more people. Which has led to a decline in the quality of life of patients and an increase in the difficulty of treatment. Unfortunately, to the best of our knowledge, no critical factors have been clearly described the specific mechanism of AVCF in postmenopausal women after PKP.\u003c/p\u003e \u003cp\u003eConsistent with previous studies (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), our study found that AVCF is a common complication after surgery. In this study, we followed up with postmenopausal women who underwent PKP and observed that the incidence of AVCF in this population was as high as 22.56% in the three years following surgery, which aligns with findings from previous studies (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn previous studies, age and osteoporosis have been found to be risk factors for adjacent vertebral fractures (\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Our findings show that this pattern also applies to postmenopausal women. The number of surgical vertebral bodies is probably not a risk factor for the development of AVCF. In our study, by univariate analysis, we found that the number of surgical vertebral body of the fracture group was significantly more than that of the non-fracture group(\u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.014). However, when we included the number of surgical vertebral body in multivariate analysis, the results showed no correlation between the number of surgical vertebral body and adjacent vertebral fractures. One-way analysis of variance showed that incidence of the surgical site (thoracic spine/lumbar spine) (\u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.001) and the single section of bone cement volume(\u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.034) were significantly greater in the fracture group than in the non-fracture group; however, further binary logistic regression analysis showed no significant correlation between the two groups.\u003c/p\u003e \u003cp\u003eIn our study, VAS scores after surgery, VHR and VKAC were important risk factors. We believe that postoperative VAS scores were significantly higher in the fracture group than in the non-fracture group, especially when the postoperative VAS is still\u0026thinsp;\u0026gt;\u0026thinsp;2.5, making patients more inclined to bed rest and less exercise, and therefore more prone to accelerated bone loss (\u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e), in addition to the fact that this behavior is not conducive to postoperative reconstruction of vertebral mechanics. Finally, the risk of developing AVCF is increased. At the same time, the VHR after surgery or the VKAC after operation in the fracture group were greater than those in the non-fracture group. This result was also consistent with previous opinion reported by previous studies (\u003cspan additionalcitationids=\"CR30\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). We conjecture that VHR and VKAC result in increased shear forces in adjacent segments, leading to an increased risk of compression fracture of adjacent vertebrae.\u003c/p\u003e \u003cp\u003eSubject to this study, postoperative pain improvement was closely associated with the incidence of AVCF and we do not recommend for force the perfect recovery of vertebral height and Vertebral kyphosis angle in the operation. First, our study indicates that the incidence of adjacent vertebral fracture is too high. Second, it may increase the risk of bone cement leakage and patient medical bills. Other risk factors were found no significant association with AVCF in our study.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eLimitation\u003c/h2\u003e \u003cp\u003eOur study has several limitations. A major limitation of this study was that the number of cases was not large. Our efforts resulted in well-selected but small patient groups, and the case data are from the same medical institution and are retrospective in nature. Additionally, all cases were from a single center, so it remains necessary to perform large-sample multicenter prospective studies in the future. Another limitation was the inconsistency of last follow-up period for every subject in our study, wildly ranging from 24 to 36 months. What\u0026rsquo;s more, many potential AVCF risk factors were not included in this study for example: nutritional deficiencies, vitamin D, calcium, whether anti-osteoporotic treatment etc. Finally, limitation was that this study only analyzed objective quantitative indicators, and did not evaluate the influence and role of subjective emotional factors. In future studies, a prospective, multi-center trial should be performed together with finite element analysis in order to study and validate the relevant risk factors.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur results indicate that in postmenopausal women undergoing PKP surgery, there is a correlation between AVCF and age, BMD, VAS scores after surgery, VHR and VKAC. VHR and VKAC are reliable predictors of the risk of adjacent vertebral compression fractures (AVCF) in postmenopausal women. VAS scores higher than 2.5 after surgery can be considered an important risk factor for the development of AVCF. These identified risk factors may lead to varying degrees of dysfunction in patients, emphasizing the need for careful observation and follow-up to prevent worsening of their clinical condition. Therefore, clinicians should give special attention to postoperative pain management in PKP patients, rather than forcing too much restoration of vertebral height and vertebral lordosis angle.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding and Disclosures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe project was generously supported by the grants from Projects of Traditional Chinese Medicine of Hubei Provincial Administration of Traditional Chinese Medicine (ZY2023M013 and ZY2021M034), Science and Technology Bureau Science and Technology Projects of Ezhou (EZ01-007-20230127).\u0026nbsp;The funding institutions had not any role in the study design, data collection, data analysis, interpretation, or writing of the report in this study.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eAuthor Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by\u0026nbsp;Fan Wu,\u0026nbsp;Xingda Chen, Jingjing Tang and Rueishiuan Jiang. The first draft of the manuscript was written by\u0026nbsp;Fan Wu,\u0026nbsp;Xingda Chen\u0026nbsp;and\u0026nbsp;Jingjing Tang, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has been reviewed by the appropriate ethics committee of Hubei Provincial Hospital of Integrated Chinese and Western Medicine (NO. K [2022] 007). and have been performed in accordance with the ethical standards laid down in an appropriate version of the 1964 Declaration of Helsinki, all persons gave their informed consent prior to their inclusion in the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eConflict of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFan Wu, Xingda Chen and Jingjing Tang declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eInformed consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all individual participants included in the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ePatel D, Liu J, Ebraheim NA. 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Osteoblast Lineage Support of Hematopoiesis in Health and Disease[J]. \u003cem\u003eJ Bone Miner Res\u003c/em\u003e. 2022 Oct;37(10):1823-1842. \u003c/li\u003e\n\u003cli\u003eCho MJ, Moon SH, Lee JH, et al. Association between osteoporotic vertebral compression fractures and age, bone mineral density, and European quality of life-5 dimensions in Korean postmenopausal women: a nationwide cross-sectional observational study[J]. \u003cem\u003eClinics in Orthopedic Surgery\u003c/em\u003e, 2021, 13(2): 207.\u003c/li\u003e\n\u003cli\u003eOsterhoff G, Asatryan G, Spiegl U J A, et al. Impact of multifidus muscle atrophy on the occurrence of secondary symptomatic adjacent osteoporotic vertebral compression fractures[J]. \u003cem\u003eCalcified Tissue International\u003c/em\u003e, 2021: 1-7.\u003c/li\u003e\n\u003cli\u003eTokeshi S, Eguchi Y, Suzuki M, et al. Relationship between skeletal muscle mass, bone mineral density, and trabecular bone score in osteoporotic vertebral compression fractures[J]. \u003cem\u003eAsian Spine Journal\u003c/em\u003e, 2021, 15(3): 365.\u003c/li\u003e\n\u003cli\u003eChanplakorn P, Lertudomphonwanit T, Daraphongsataporn N, et al. Development of prediction model for osteoporotic vertebral compression fracture screening without using clinical risk factors, compared with FRAX and other previous models[J]. \u003cem\u003eArchives of Osteoporosis\u003c/em\u003e, 2021, 16(1): 84.\u003c/li\u003e\n\u003cli\u003eEdidin AA, Ong KL, Lau E, et al. Morbidity and Mortality After Vertebral Fractures: Comparison of Vertebral Augmentation and Nonoperative Management in the Medicare Population[J]. \u003cem\u003eSpine\u003c/em\u003e, 2015, 40（15）:1228-1241.\u003c/li\u003e\n\u003cli\u003eSawicki P, Tałałaj M, Życińska K, et al. Comparison of the characteristics of back pain in women with postmenopausal osteoporosis with and without vertebral compression fracture: a retrospective study at a single osteoporosis center in Poland[J]. \u003cem\u003eMedical Science Monitor: International Medical Journal of Experimental and Clinical Research\u003c/em\u003e, 2021, 27: e929853-1.\u003c/li\u003e\n\u003cli\u003eMills E S, Ton A T, Bouz G, et al. Acute operative management of osteoporotic vertebral compression fractures is associated with decreased morbidity[J]. \u003cem\u003eAsian Spine Journal\u003c/em\u003e, 2022, 16(5): 634-642.\u003c/li\u003e\n\u003cli\u003eJeon I, Kim S W, Yu D. Paraspinal muscle fatty degeneration as a predictor of progressive vertebral collapse in osteoporotic vertebral compression fractures[J]. \u003cem\u003eThe Spine Journal,\u003c/em\u003e 2022, 22(2): 313-320.\u003c/li\u003e\n\u003cli\u003eWang Q, Sun C, Zhang L, et al. High-versus low-viscosity cement vertebroplasty and kyphoplasty for osteoporotic vertebral compression fracture: a meta-analysis[J]. \u003cem\u003eEuropean Spine Journal\u003c/em\u003e, 2022, 31(5): 1122-1130.\u003c/li\u003e\n\u003cli\u003eKim WJ, Ma SB, Shin HM, et al. Correlation of Sagittal Imbalance and Recollapse after Percutaneous Vertebroplasty for Thoracolumbar Osteoporotic Vertebral Compression Fracture: A Multivariate Study of Risk Factors[J]. \u003cem\u003eAsian Spine Journal\u003c/em\u003e, 2022, 16(2): 231.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"osteoporotic vertebral compression fractures, adjacent vertebral compression fracture, risk factor, percutaneous kyphoplasty, postmenopausal women","lastPublishedDoi":"10.21203/rs.3.rs-4480156/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4480156/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo evaluate the risk factors for adjacent vertebral compression fracture(AVCF) following the surgery of percutaneous kyphoplasty (PKP) in postmenopausal women.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eTwo hundred and ninety-seven postmenopausal female patients, underwent PKP surgery between January 2016 and December 2020, were divided into two groups according to whether or not AVCF. Receiver operating characteristic(ROC) curves were generated to analyze the sensitivity and specificity of the relative risk factors in the identification of AVCF.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIn this study of 297 postmenopausal women who underwent PKP, 67 developed AVCF during follow-up. There were no significant differences in BMI, surgical method, or cement leakage between the groups. The AVCF group was older, had lower BMD, less bone cement volume per section, higher VHA, and larger VKAC. The non-fracture group had lower postoperative VAS and fewer surgical vertebrae. The model showed good discrimination with age, BMD, postoperative VAS, VHR, and VKAC. ROC analysis indicated that a postoperative VAS score\u0026thinsp;\u0026gt;\u0026thinsp;2.5 was highly predictive of AVCF in postmenopausal women after PKP.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eClinicians should pay particular attention to postoperative pain management in PKP patients, rather than forcing too much restoration of vertebral height and vertebral lordosis angle.\u003c/p\u003e","manuscriptTitle":"Risk factor analysis of adjacent vertebral compression fracture following the surgery of percutaneous kyphoplasty in postmenopausal women","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-12 19:18:32","doi":"10.21203/rs.3.rs-4480156/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-09-17T06:17:38+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-11T23:38:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"11215101540958105146790738010002402525","date":"2024-08-27T23:00:46+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-08T10:52:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"100949293195864057796909593609342252399","date":"2024-08-04T13:59:41+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-13T01:06:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"205118611132277116899333464644027749891","date":"2024-06-28T00:46:41+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-06-06T04:17:03+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-06T04:16:02+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-05-30T07:39:47+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-29T03:50:18+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-05-26T13:11:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8c5912a3-29b0-44e8-af96-97d61b394432","owner":[],"postedDate":"June 12th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-02-24T16:05:55+00:00","versionOfRecord":{"articleIdentity":"rs-4480156","link":"https://doi.org/10.1038/s41598-025-85381-9","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-02-17 15:57:23","publishedOnDateReadable":"February 17th, 2025"},"versionCreatedAt":"2024-06-12 19:18:32","video":"","vorDoi":"10.1038/s41598-025-85381-9","vorDoiUrl":"https://doi.org/10.1038/s41598-025-85381-9","workflowStages":[]},"version":"v1","identity":"rs-4480156","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4480156","identity":"rs-4480156","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}