Magnetic resonance imaging-based bone and muscle quality parameters for predicting clinical subsequent vertebral fractures after percutaneous vertebral augmentation.

Background: Clinical subsequent vertebral fracture (SVF) is a common complication following percutaneous vertebral augmentation treatment for osteoporotic vertebral compression fracture. Magnetic resonance imaging (MRI)-based vertebral bone quality (VBQ) score, cross-sectional area (CSA), and degree of fat infiltration (DFI) of paravertebral muscles are effective predictors of spinal surgery-related complications. However, the relationship between these parameters and SVF remains unclear. The purpose of this study was to evaluate the utility of these MRI-based bone and muscle quality parameters for predicting SVF after percutaneous vertebral augmentation. Methods: This retrospective study included consecutive patients with osteoporotic vertebral compression fracture treated with percutaneous vertebral augmentation at Xuzhou Central Hospital between January 2017 and December 2020. Clinical SVF was diagnosed if there was new episode of back pain and a confirmed acute fracture on MRI. Noncontrast T1-weighted MRI and axial T2-weighted MRI were used to determine the VBQ score and measure CSA and DFI, respectively. A multivariable logistic regression analysis adjusted for confounding factors was performed to determine the correlation between VBQ score, DFI, CSA, and SVF. Receiver operating characteristic curves were plotted, and the area under the curve (AUC) was calculated to evaluate the predictive ability of SVF. The DeLong test was used to compare the predictive ability. Pearson correlation analysis was used to characterize the relationships between VBQ score and both CSA and DFI. Results: A total of 289 patients were included in this study, and 41 (14.2%) patients developed SVF. Compared with the non-SVF group, the SVF group had a higher VBQ score (3.83 Conclusions: The VBQ score and DFI were independent predictors for clinical SVF after percutaneous vertebral augmentation. The combination of VBQ score and DFI significantly improved the predictive accuracy. Moreover, there was a significant positive correlation between the VBQ score and DFI.