Association of Postoperative Adjacent Vertebral Hounsfield Units with Adjacent Vertebral Fracture in OVCF Patients After Vertebral Augmentation

Li Qingbin; Xue Youdi; Wang Chunzeng; Zhao Jixiang

Abstract：Objective To explore the relationship between the trabecular CT value of the adjacent vertebrae and the occurrence of adjacent vertebral fractures(AVF)after percutaneous vertebral augmentation(PVA).Methods We retrospectively enrolled 460 patients with osteoporosis vertebral compression fractures(OVCF)who underwent PVA between 2016 and 2019.Patients were divided into two groups based on the occurrence of AVF:the AVF group(n=82,31 males and 51 females,mean age 71.90±8.01 years)and the non-AVF group(n=378,138 males and 240 females,mean age 72.50±8.95 years).Variables included age,gender,body mass index(BMI),fracture location,prior fracture history,adjacent vertebral CT value(Hounsfield unit,HU),and intervertebral cement leakage.We performed univariate and multivariate logistic regression analyses to identify risk factors for AVF.The AVF group was further divided into two subgroups based on the presence of intervertebral cement leakage:the non-leakage group(n=53)and the leakage group(n=29).We compared adjacent vertebral HU values and survival time(defined as the interval from PVA to AVF occurrence during follow-up)between these two subgroups and used Kaplan-Meier survival analysis to assess the impact of cement leakage on AVF-free survival time.Results Multivariate regression analysis revealed that lower adjacent vertebral CT values[OR=0.972,95％CI(0.959,0.985),P＜0.001]and intervertebral cement leakage[OR=2.618,95％CI(1.415,4.844),P=0.002]were independent risk factors for AVF after PVA.In the AVF group,the adjacent vertebral HU values were(64.23±20.49)HU and survival time was 31.42±18.73 months in the non-leakage group,compared to(78.05±16.41)HU and(22.07±13.83)months in the leakage group.Significant differences were observed between the two subgroups(P＜0.001).Kaplan-Meier curves showed that the AVF-free survival time was shorter in the leakage group compared to the non-leakage group(log-rank test,P=0.014).Conclusion Lower adjacent vertebral CT values and intervertebral cement leakage are significant risk factors for AVF after PVA.When intervertebral cement leakage is present,a relatively higher adjacent vertebral CT value may lead to earlier AVF occurrence.