ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2025
CT- and MRI-based endplate osteoporosis status assessment for predicting adjacent vertebral fractures after thoracolumbar percutaneous kyphoplasty: a matched comparison study.
Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeThis study aimed to investigate the predictive value of adjacent vertebral endplate osteoporotic status for adjacent vertebral fracture (AVF) after percutaneous kyphoplasty (PKP) for treating osteoporotic vertebral compression fracture (OVCF) and compared it with vertebral cancellous bone.
methodsThis study retrospectively analyzed consecutive patients with OVCF who underwent PKP. Participants were categorized into the study group (49 patients with AVF) and the control group (49 matched patients without AVF). The vertebral Hounsfield units (VHU), endplate HU (EHU), vertebral bone quality (VBQ), and endplate bone quality (EBQ) scores were calculated using preoperative CT and MRI. To identify the predictive ability of the HU and EBQ scores, multivariable logistic regression and receiver operating characteristic (ROC) curve analyses were conducted.
resultsVHU (p = 0.006), EHU proximal to the fracture segment (pEHU) (p = 0.001), average level of EHUs (aEHU) (p = 0.001), and EBQ score proximal to the fracture segment (pEBQ score) (p = 0.034) of the adjacent fractured vertebrae (AFV) in the study group were significantly different from the control study. The lower VHU (OR = 0.981, p = 0.007), pEHU (OR = 0.984, p < 0.001), lower aEHU (OR = 0.986, p = 0.002), and higher pEBQ score (OR = 1.002, p = 0.050) of the AFV were determined as the independent predictors for AVF. The ROC curve analysis revealed that the adjusted area under the curve (AUC) for the pEHU was 0.756 and the most suitable threshold was 254.87 (sensitivity: 69.4% and specificity: 77.6%), indicating that the predictive performance of pEHU was relatively higher. Further, the adjusted AUCs for the VHU, aEHU, and pEBQ scores were 0.703, 0.699, and 0.666, respectively.
conclusionThis study revealed that the endplate osteoporosis status predicted AVF better than the vertebral cancellous bone and the predictive performance of pEHU was relatively higher.
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