Figure - available from: Frontiers in Surgery
This content is subject to copyright.
In group A, a patient with L2 vertebral fracture with upper endplate fracture was treated with bone cement, and the bone cement was completely filled in the fracture fissure of upper endplate. (A–B) Preoperative x-ray. (C–D) Preoperative MRI. (E–F) x-ray after surgery.
Source publication
Background
Endplate fractures is an important factor affecting the curative effect of percutaneous kyphoplasty for spinal fracture. The purpose of this study is to investigate the effect of sealing endplate fracture with bone cement on minimally invasive treatment of spinal fracture.
Methods
A total of 98 patients with osteoporotic vertebral fract...
Similar publications
Objective:
To investigate the clinical efficacy of Percutaneous Kyphoplasty (PKP) in male and female patients.
Method:
The clinical data of patients treated with PKP in our hospital from January 2018 to October 2020 were analyzed retrospectively. These patients were divided into female group and male group according to gender differences. The vi...
Citations
... When the endplate fractures, the pressure it bears is uneven, leading to accelerated degeneration of the intervertebral disc (42). Studies have found that patients with endplate fractures who undergo cement surgery have an increased risk of cement leakage and may even experience fractures in other vertebral bodies (43). Based on these two points, when the bone cement seeps into the intervertebral disc through the fracture line of the endplate, it undergoes degeneration. ...
Objective
This study aimed to develop and validate a new nomogram model that can predict new vertebral fractures after surgery for osteoporotic compression fractures to optimize surgical plans and reduce the incidence of new vertebral compression fractures.
Methods
420 patients with osteoporotic vertebral compression fractures were randomly sampled using a computer at a fixed ratio; 80% of the patients were assigned to the training set, while the remaining 20% were assigned to the validation set. The least absolute shrinkage and selection operator (LASSO) regression method was applied to screen the factors influencing refracture and construct a predictive model using multivariate logistic regression analysis.
Results
The results of the multivariate logistic regression analysis showed a significant correlation between bone cement leakage, poor cement dispersion, the presence of fractures in the endplate, and refractures. The receiver operating characteristic curve (ROC) results showed that the area under the ROC curve (AUC) of the training set was 0.974 and the AUC of the validation set was 0.965, which proves that this prediction model has a good predictive ability. The brier score for the training set and validation set are 0.043 and 0.070, respectively, indicating that the model has high accuracy. Moreover, the calibration curve showed a good fit with minimal deviation, demonstrating the model’s high discriminant ability and excellent fit. The decision curve indicated that the nomogram had positive predictive ability, indicating its potential as a practical clinical tool.
Conclusion
Cement leakage, poor cement dispersion, and presence of fractures in the endplate are selected through LASSO and multivariate logistic regressions and included in the model development to establish a nomogram. This simple prediction model can support medical decision-making and maybe feasible for clinical practice.
... Several studies have suggested that endplate destruction leads to stress concentration, thereby compromising the biomechanical stability of the spinal column. Moreover, the loss of endplate integrity may lead to bone cement leakage, both of which contribute to the increased incidence of NVCF [45,46]. However, further investigations are required to determine whether endplate repair can mitigate NVCF occurrence in patients with osteoporosis. ...
Background
Postmenopausal women face a heightened risk of developing new vertebral compression fractures (NVCFs) following percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fractures (OVCFs). This study aimed to develop and validate a visual nomogram model capable of accurately predicting NVCF occurrence post-PKP to optimize treatment strategies and minimize occurrence.
Methods
This retrospective study included postmenopausal women diagnosed with OVCF who underwent PKP at the Affiliated Hospital of Shandong University of Traditional Chinese Medicine between January 2016 and January 2021. Patient data, including basic information, surgical details, imaging records, and laboratory findings, were collected. The patients were categorized into two groups based on NVCF occurrence within 2 years post-PKP: the NVCF group and the non-NVCF group. Following the utilization of least absolute shrinkage and selection operator (LASSO) regression for feature selection, a nomogram was constructed. Model differentiation, calibration, and clinical applicability were evaluated using receiver operating characteristic (ROC), calibration, and decision (DCA) curve analyses.
Results
In total, 357 patients were included in the study. LASSO regression analysis indicated that cement leakage, poor cement diffusion, and endplate fracture were independent predictors of NVCF. The nomogram demonstrated excellent predictive accuracy and clinical applicability.
Conclusions
This study used LASSO regression to identify three independent predictors of NVCF and developed a predictive model that could effectively predict NVCF occurrence in postmenopausal women. This simple prediction model can support medical decision-making and is feasible for clinical practice.
... Sun et al. (13) reported that cement distribution proximal to the adjacent vertebral body (distributed at the disc level or endplate level) could increase the risk of post-vertebroplasty fractures in adjacent vertebral bodies. Similarly, Zhao et al. (37) found that the diffusion of bone cement into cracks in the injured endplate may increase the incidence of adjacent vertebral fractures. These results further explain the differences in the numbers of DDC cases induced by different cement distribution patterns. ...
Background
The influence of vertebral augmentation on adjacent intervertebral discs remains controversial. The purpose of this study is to evaluate the effect of bone cement distribution on adjacent disc degeneration after vertebral augmentation for osteoporotic vertebral compression fractures (OVCFs).
Methods
Patients with single level OVCF and upper endplate injury who underwent vertebral augmentation were enrolled. The patients were divided into four groups: Group A: bone cement contacted both the cranial and the distal endplates; Group B: bone cement only contacted the cranial endplate; Group C: bone cement only contacted the distal endplate; and Group D: bone cement contacted neither the cranial nor the distal endplates. The cranial discs of the fractured vertebrae were defined as adjacent discs and the upper discs proximally to the adjacent discs were defined as control discs. Degenerative disc change (DDC) was defined as a deteriorated postoperative Pfirrmann score compared with the preoperative score on MR images. The number of DDC cases and the disc heights were analyzed among the groups.
Results
A total of 184 patients with an average follow-up time of 28.6 months were included. The number of DDC cases in the adjacent discs was significantly higher than in the control discs in groups A ( p < 0.001), B ( p = 0.002), and D ( p = 0.028), whereas the difference in group C was not statistically significant ( p = 0.237). The incidence of adjacent disc degeneration was significantly higher in group A than that in group C ( p = 0.06). The adjacent disc heights decreased significantly in groups A, B, and D ( p < 0.001, p < 0.001, and p = 0.012, respectively), but did not decrease significantly in group C ( p = 0.079). However, no statistical differences were detected among the four groups with respect to the preoperative adjacent disc height, follow-up adjacent disc height, preoperative control disc height, or follow-up control disc height.
Conclusion
Bone cement distribution influences adjacent disc degeneration after vertebral augmentation in OVCFs. Cement distribution proximal to the injured endplate can accelerate adjacent disc degeneration, and cement in contact with both the cranial and distal endplates can induce a higher incidence of adjacent disc degeneration.
... Some studies suggest that endplate destruction results in stress concentration, compromising the biomechanical stability of the spinal sequence. Moreover, the loss of endplate integrity may lead to bone cement leakage, both of which contribute to the higher incidence of NVCF [43,44] . However, further investigation is required to determine whether endplate repair can reduce the occurrence of NVCF in patients with osteoporosis. ...
Background: Postmenopausal women face a heightened risk of developing new vertebral compression fractures (NVCF) after experiencing osteoporotic vertebral compression fractures (OVCF) and undergoing percutaneous kyphoplasty (PKP). This study aims to develop and validate a novel Nomogram visual model capable of accurately predicting the occurrence of NVCF following PKP. The objective is to optimize treatment strategies and minimize the occurrence of new fractures.
Methods: A retrospective study was conducted on postmenopausal women diagnosed with OVCF who underwent PKP at the Affiliated Hospital of Shandong University of Traditional Chinese Medicine between January 2016 and January 2021. Patient data, including basic information, surgical details, imaging records, and laboratory test results, were collected. The patients were categorized into two groups based on the occurrence of NVCF: a new fracture group and a no new fracture group. Feature selection was performed using LASSO regression, and a Nomogram diagram was constructed. The model's differentiation, calibration, and clinical applicability were evaluated through receiver operating characteristic curve (ROC) analysis, calibration curves, and decision curve analysis (DCA).
Results: In this study, a total of 357 patients were included. The results of LASSO regression analysis indicated that cement leakage, poor cement diffusion, and endplate fracture were identified as independent predictors of NVCF. The development and verification of the Nomogram demonstrated its predictive ability and clinical applicability.
Conclusions: The study utilized LASSO regression to identify three independent predictors and developed a predictive model for predicting the occurrence of NVCF in postmenopausal women. The developed model effectively predicts the occurrence of NVCF in this population.
