Combined Prediction of Adjacent Vertebral Fracture Using Postoperative Spine-Pelvis Dynamic Posture and Sagittal Balance Parameters in Patients Undergoing Percutaneous Kyphoplasty
WU Hailong, ZHANG Chi, LI Yipeng, et al
Shijiazhuang People's Hospital, Hebei Shijiazhuang 050000, China
Abstract：Objective: To investigate the value of combining postoperative spine-pelvis dynamic posture and sagittal balance parameters in predicting adjacent vertebral fractures following percutaneous kyphoplasty (PKP).Methods: A total of 106 patients with osteoporotic vertebral compression fracture (OVCF) from January 2021 to June 2022 were selected, all of whom received PKP surgery. Dynamic spindle-pelvis postural parameters (spine rotation amplitude at rest, scoliosis amplitude during walking, and forward inclination amplitude), sagittal plane balance parameters [Sagittal axis (SVA), sacral inclination Angle (SS), thoracic kyphosis Angle (TK), pelvic incidence Angle (PI), lumbar lordosis Angle (LL), pelvic inclination Angle (PT), and T1 pelvic Angle (TPA)] were measured 3 months after surgery. Patients were followed up for one year and divided into the fracture group (37 cases) and non-fracture group (69 cases) based on the occurrence of adjacent vertebral fractures. The dynamic posture and sagittal plane balance parameters of the spine and pelvis were compared between the two groups, and the correlation and predictive value of the dynamic posture and sagittal plane balance parameters were analyzed. Results: The rotation amplitude of the fracture group was smaller, while lateral and forward inclination amplitudes were larger than those of the non-fracture group (P<0.05). SVA and TK were greater in the fracture group, while LL, SS, and PI were smaller compared to the non-fracture group (P<0.05). Rotation amplitude showed a negative correlation with SVA and TK, and a positive correlation with LL, SS, and PI. Lateral and forward inclination amplitudes were positively correlated with SVA and TK, and negatively correlated with LL, SS, and PI (P<0.05). High values of lateral and forward inclination, SVA, TK, and low values of rotation amplitude, LL, SS, PI significantly increased the risk of adjacent vertebral fractures (P<0.05). The combined prediction of spine-pelvis dynamic posture parameters and sagittal balance parameters for adjacent vertebral fractures had an AUC of 0.920 (95% CI: 0.851–0.964), sensitivity of 89.19%, and specificity of 82.61%, outperforming predictions based solely on dynamic posture or sagittal balance parameters. Conclusion: Postoperative spine-pelvis dynamic posture and sagittal balance parameters are significantly correlated in OVCF patients undergoing PKP and are associated with an increased risk of adjacent vertebral fractures. The combined prediction of these parameters provides a reliable and superior method for predicting such fractures.
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2024, Vol. 30 
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