Improved Kyphotic Restoration Reduces the Incidence of Adjacent Vertebral Fracture in Patients With Osteoporotic Vertebral Compression Fractures Treated by Percutaneous Kyphoplasty: A Clinical Study and Corresponding Numerical Simulations
ABSTRACT Objective Adjacent vertebral fracture (AVF) is a commonly observed complication in patients with osteoporotic vertebral compressive fractures (OVCF) following percutaneous kyphoplasty (PKP). The primary etiology of this complication is the deterioration of the biomechanical environment. Loc...
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Wiley
2025-06-01
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| Series: | Orthopaedic Surgery |
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| Online Access: | https://doi.org/10.1111/os.70046 |
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| author | Jian Yang Zan Chen Lipeng Zheng Fei Lei Wenhao Yang Yueming Song Jingchi Li |
| author_facet | Jian Yang Zan Chen Lipeng Zheng Fei Lei Wenhao Yang Yueming Song Jingchi Li |
| author_sort | Jian Yang |
| collection | DOAJ |
| description | ABSTRACT Objective Adjacent vertebral fracture (AVF) is a commonly observed complication in patients with osteoporotic vertebral compressive fractures (OVCF) following percutaneous kyphoplasty (PKP). The primary etiology of this complication is the deterioration of the biomechanical environment. Local kyphotic deformity plays a critical role in influencing the direction of load transmission, which subsequently affects the local biomechanical conditions. However, whether the improved restoration of sagittal alignment can biomechanically lower the incidence of AVF remains to be determined. This paper aimed to investigate the influence of kyphotic deformity on AVF and its corresponding biomechanical mechanism. Methods Clinical data of PKP‐treated patients with OVCF were retrospectively reviewed in this study. The current patient cohort was divided into two groups based on the clinical outcomes observed during the follow‐up period (with and without AVF). Kyphotic angles were measured from the preoperative and postoperative lateral radiographs of these patients, and the variations between these values were calculated to denote the kyphotic restoration value. Significant differences in these parameters were analyzed between patients with and without AVF. Moreover, the biomechanical influences of segmental kyphotic angles on adjacent segment stress values were determined using a well‐validated numerical model to explain the biomechanical mechanisms underlying clinically observed phenomena. Results Clinical data of 121 PKP‐treated patients with OVCF were enrolled in this study. The preoperative kyphotic angles between the two groups were comparable (12.83 ± 5.98, 12.93 ± 6.66, p = 0.942). By contrast, compared with patients with AVF, patients without AVF suffered significantly lower postoperative kyphotic angle values (10.11 ± 4.84, 7.85 ± 5.24, p = 0.044). Correspondingly, the kyphotic restoration was significantly better in patients without AVF (2.72 ± 2.26, 5.08 ± 4.2, p = 0.055). In addition, stress concentration is more evident in the model with severe fracture segmental kyphosis. Conclusions The clinical review and biomechanical simulations revealed that a greater degree of kyphotic correction during PKP procedures, along with a decreased postoperative kyphotic deformity, may help lower the incidence of AVF by easing stress concentration in the neighboring vertebral bodies. This topic deserves further validation through future prospective studies. |
| format | Article |
| id | doaj-art-2c5fa7645c9e49b7a7a4add8aa8e656b |
| institution | Kabale University |
| issn | 1757-7853 1757-7861 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Wiley |
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| series | Orthopaedic Surgery |
| spelling | doaj-art-2c5fa7645c9e49b7a7a4add8aa8e656b2025-08-20T03:45:47ZengWileyOrthopaedic Surgery1757-78531757-78612025-06-011761721173110.1111/os.70046Improved Kyphotic Restoration Reduces the Incidence of Adjacent Vertebral Fracture in Patients With Osteoporotic Vertebral Compression Fractures Treated by Percutaneous Kyphoplasty: A Clinical Study and Corresponding Numerical SimulationsJian Yang0Zan Chen1Lipeng Zheng2Fei Lei3Wenhao Yang4Yueming Song5Jingchi Li6Department of Orthopedic Surgery and Orthopedic Research Institute West China Hospital/West China School of Medicine for Sichuan University Chengdu ChinaDepartment of Orthopedic The Affliated Hospital of Southwest Medical University Luzhou ChinaDepartment of Orthopedic The Affliated Hospital of Southwest Medical University Luzhou ChinaDepartment of Orthopedic The Affliated Hospital of Southwest Medical University Luzhou ChinaDepartment of Orthopedics, Luzhou Key Laboratory of Orthopedic Disorders, The Affiliated Traditional Chinese Medicine Hospital Southwest Medical University Luzhou ChinaDepartment of Orthopedic Surgery and Orthopedic Research Institute West China Hospital/West China School of Medicine for Sichuan University Chengdu ChinaDepartment of Orthopedics, Luzhou Key Laboratory of Orthopedic Disorders, The Affiliated Traditional Chinese Medicine Hospital Southwest Medical University Luzhou ChinaABSTRACT Objective Adjacent vertebral fracture (AVF) is a commonly observed complication in patients with osteoporotic vertebral compressive fractures (OVCF) following percutaneous kyphoplasty (PKP). The primary etiology of this complication is the deterioration of the biomechanical environment. Local kyphotic deformity plays a critical role in influencing the direction of load transmission, which subsequently affects the local biomechanical conditions. However, whether the improved restoration of sagittal alignment can biomechanically lower the incidence of AVF remains to be determined. This paper aimed to investigate the influence of kyphotic deformity on AVF and its corresponding biomechanical mechanism. Methods Clinical data of PKP‐treated patients with OVCF were retrospectively reviewed in this study. The current patient cohort was divided into two groups based on the clinical outcomes observed during the follow‐up period (with and without AVF). Kyphotic angles were measured from the preoperative and postoperative lateral radiographs of these patients, and the variations between these values were calculated to denote the kyphotic restoration value. Significant differences in these parameters were analyzed between patients with and without AVF. Moreover, the biomechanical influences of segmental kyphotic angles on adjacent segment stress values were determined using a well‐validated numerical model to explain the biomechanical mechanisms underlying clinically observed phenomena. Results Clinical data of 121 PKP‐treated patients with OVCF were enrolled in this study. The preoperative kyphotic angles between the two groups were comparable (12.83 ± 5.98, 12.93 ± 6.66, p = 0.942). By contrast, compared with patients with AVF, patients without AVF suffered significantly lower postoperative kyphotic angle values (10.11 ± 4.84, 7.85 ± 5.24, p = 0.044). Correspondingly, the kyphotic restoration was significantly better in patients without AVF (2.72 ± 2.26, 5.08 ± 4.2, p = 0.055). In addition, stress concentration is more evident in the model with severe fracture segmental kyphosis. Conclusions The clinical review and biomechanical simulations revealed that a greater degree of kyphotic correction during PKP procedures, along with a decreased postoperative kyphotic deformity, may help lower the incidence of AVF by easing stress concentration in the neighboring vertebral bodies. This topic deserves further validation through future prospective studies.https://doi.org/10.1111/os.70046adjacent vertebral fracturekyphotic angleosteoporotic vertebral compressive fracturepercutaneous vertebralplastystress concentration |
| spellingShingle | Jian Yang Zan Chen Lipeng Zheng Fei Lei Wenhao Yang Yueming Song Jingchi Li Improved Kyphotic Restoration Reduces the Incidence of Adjacent Vertebral Fracture in Patients With Osteoporotic Vertebral Compression Fractures Treated by Percutaneous Kyphoplasty: A Clinical Study and Corresponding Numerical Simulations Orthopaedic Surgery adjacent vertebral fracture kyphotic angle osteoporotic vertebral compressive fracture percutaneous vertebralplasty stress concentration |
| title | Improved Kyphotic Restoration Reduces the Incidence of Adjacent Vertebral Fracture in Patients With Osteoporotic Vertebral Compression Fractures Treated by Percutaneous Kyphoplasty: A Clinical Study and Corresponding Numerical Simulations |
| title_full | Improved Kyphotic Restoration Reduces the Incidence of Adjacent Vertebral Fracture in Patients With Osteoporotic Vertebral Compression Fractures Treated by Percutaneous Kyphoplasty: A Clinical Study and Corresponding Numerical Simulations |
| title_fullStr | Improved Kyphotic Restoration Reduces the Incidence of Adjacent Vertebral Fracture in Patients With Osteoporotic Vertebral Compression Fractures Treated by Percutaneous Kyphoplasty: A Clinical Study and Corresponding Numerical Simulations |
| title_full_unstemmed | Improved Kyphotic Restoration Reduces the Incidence of Adjacent Vertebral Fracture in Patients With Osteoporotic Vertebral Compression Fractures Treated by Percutaneous Kyphoplasty: A Clinical Study and Corresponding Numerical Simulations |
| title_short | Improved Kyphotic Restoration Reduces the Incidence of Adjacent Vertebral Fracture in Patients With Osteoporotic Vertebral Compression Fractures Treated by Percutaneous Kyphoplasty: A Clinical Study and Corresponding Numerical Simulations |
| title_sort | improved kyphotic restoration reduces the incidence of adjacent vertebral fracture in patients with osteoporotic vertebral compression fractures treated by percutaneous kyphoplasty a clinical study and corresponding numerical simulations |
| topic | adjacent vertebral fracture kyphotic angle osteoporotic vertebral compressive fracture percutaneous vertebralplasty stress concentration |
| url | https://doi.org/10.1111/os.70046 |
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