Percutaneous kyphoplasty and risk factors for new vertebral compression fractures: The role of bone quality and paraspinal muscle degeneration

Osteoporotic vertebral compression fractures (OVCF) are a common complication of osteoporosis, particularly in elderly populations. Percutaneous kyphoplasty (PKP) is a minimally invasive procedure that provides pain relief and spinal stability for patients with OVCF. However, new vertebral compression fractures (NVCF) can occur in 2% to 38% of patients following PKP, posing a significant clinical challenge. Identifying risk factors for NVCF is essential to improve patient outcomes and guide preventive strategies. A retrospective study was conducted on 193 patients aged 60 years or older who underwent PKP for OVCF at a tertiary hospital between January 2017 and December 2023. Patients were divided into 2 groups based on the occurrence of NVCF during follow-up. Preoperative imaging (CT, X-ray, and MRI) and hospital records were analyzed to assess risk factors, including age, gender, bone mineral density, Hounsfield unit (HU) values, paraspinal muscle degeneration, cement volume, and leakage. Statistical analyses were performed using SPSS software, with multivariate regression analysis identifying independent predictors of NVCF. Among the 193 patients, 23.3% (n = 45) developed NVCF during follow-up, while 76.7% (n = 148) did not. Lower HU values (mean 58.1 ± 18.68 vs 79.5 ± 25.44, P = .0001) and increased fatty infiltration of paraspinal muscles were identified as significant independent risk factors for NVCF. Multivariate regression analysis confirmed lower HU values (OR = 0.965, P < .001) and fatty infiltration of the erector spinae muscle (OR = 1.034, P = .038) as predictors. Other factors, such as age, gender, bone mineral density, cement volume, and leakage, were not significantly associated with NVCF. Lower HU values and paraspinal muscle degeneration, particularly reduced functional muscle mass and increased fatty infiltration, are significant predictors of NVCF following PKP. Preoperative evaluations should include HU measurements and paraspinal muscle assessments to identify high-risk patients. Postoperative management should focus on improving bone density and muscle health through targeted therapies and lifestyle modifications to reduce fracture risk.