Influence of bone cement volume and distribution on refracture of operated and adjacent vertebrae after percutaneous vertebroplasty

Percutaneous vertebroplasty (PVP) is a first-line minimally invasive treatment for osteoporotic vertebral compression fractures (OVCFs). Postoperative refracture of the operated or adjacent vertebrae remains a common complication that affects long-term efficacy. Bone cement volume and distribution are considered key influencing factors, but large-sample studies with comprehensive and detailed statistical analysis are still insufficient. A retrospective cohort study was conducted including 326 patients with single-level OVCFs who underwent unilateral PVP between January 2018 and December 2022. Patients were divided into a refracture group ( n = 62) and a non-refracture group ( n = 264) according to whether symptomatic refracture occurred during follow-up of at least 12 months. Demographic characteristics, laboratory indicators, surgical parameters, and radiological indexes were collected. Univariate analysis and binary logistic regression analysis were used to screen for independent risk factors of postoperative refracture. The overall refracture rate was 19.0% (62/326). Univariate analysis showed significant differences in age, BMD T-value, serum 25-hydroxyvitamin D, bone cement volume stratified into three groups, detailed bone cement distribution types (Type I–V), intervertebral cement leakage, pelvic incidence, and postoperative local kyphotic angle between the two groups (all P < 0.05). Logistic regression analysis showed that intervertebral cement leakage (OR = 5.82, 95%CI: 3.16–10.71, P < 0.001), asymmetric cement distribution including Type IV (OR = 12.35, 95%CI: 4.26–35.78, P < 0.001) and Type V (OR = 15.62, 95%CI: 5.41–45.13, P < 0.001), cement volume ≤ 3.0 mL (OR = 2.61, 95%CI: 1.43–4.76, P = 0.002), BMD T-value ≤ − 3.5 (OR = 2.17, 95%CI: 1.19–3.96, P = 0.011), and pelvic incidence > 55° (OR = 1.89, 95%CI: 1.04–3.42, P = 0.036) were independent risk factors for postoperative refracture. Postoperative refracture after PVP is a multifactorial complication. Intervertebral cement leakage, unilateral and asymmetric cement distribution (Type IV and Type V), insufficient cement volume (≤ 3.0 mL), severe osteoporosis, and high pelvic incidence are independent risk factors. Surgeons should pursue symmetric and sufficient cement distribution, strictly prevent intervertebral cement leakage, and combine standardized anti-osteoporosis treatment to reduce the risk of postoperative refracture.