Improved Kyphotic Restoration Reduces the Incidence of Adjacent Vertebral Fracture in Patients With Osteoporotic Vertebral Compression Fractures Treated by Percutaneous Kyphoplasty: A Clinical Study and Corresponding Numerical Simulations

Abstract

Objective: Adjacent vertebral fracture (AVF) is a commonly observed complication in patients with osteoporotic vertebral compressive fractures (OVCF) following percutaneous kyphoplasty (PKP). The primary etiology of this complication is the deterioration of the biomechanical environment. Local kyphotic deformity plays a critical role in influencing the direction of load transmission, which subsequently affects the local biomechanical conditions. However, whether the improved restoration of sagittal alignment can biomechanically lower the incidence of AVF remains to be determined. This paper aimed to investigate the influence of kyphotic deformity on AVF and its corresponding biomechanical mechanism.

Methods: Clinical data of PKP-treated patients with OVCF were retrospectively reviewed in this study. The current patient cohort was divided into two groups based on the clinical outcomes observed during the follow-up period (with and without AVF). Kyphotic angles were measured from the preoperative and postoperative lateral radiographs of these patients, and the variations between these values were calculated to denote the kyphotic restoration value. Significant differences in these parameters were analyzed between patients with and without AVF. Moreover, the biomechanical influences of segmental kyphotic angles on adjacent segment stress values were determined using a well-validated numerical model to explain the biomechanical mechanisms underlying clinically observed phenomena.

Results: Clinical data of 121 PKP-treated patients with OVCF were enrolled in this study. The preoperative kyphotic angles between the two groups were comparable (12.83 ± 5.98, 12.93 ± 6.66, p = 0.942). By contrast, compared with patients with AVF, patients without AVF suffered significantly lower postoperative kyphotic angle values (10.11 ± 4.84, 7.85 ± 5.24, p = 0.044). Correspondingly, the kyphotic restoration was significantly better in patients without AVF (2.72 ± 2.26, 5.08 ± 4.2, p = 0.055). In addition, stress concentration is more evident in the model with severe fracture segmental kyphosis.

Conclusions: The clinical review and biomechanical simulations revealed that a greater degree of kyphotic correction during PKP procedures, along with a decreased postoperative kyphotic deformity, may help lower the incidence of AVF by easing stress concentration in the neighboring vertebral bodies. This topic deserves further validation through future prospective studies.

Keywords

adjacent vertebral fracture / kyphotic angle / osteoporotic vertebral compressive fracture / percutaneous vertebralplasty / stress concentration

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