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The goal of this study was to assess its significance in identifying patients at greater risk for postoperative kyphotic deformities and to refine clinical management strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-center retrospective study analyzed 182 patients with OVCFs who underwent PKP between January 2019 and December 2022. Patients were categorized into two groups based on the presence or absence of BLS on preoperative MRI: the BLS group and the non-black line sign (NBLS) group. Radiological and clinical outcomes were compared between these two groups. Both univariate and multivariate analyses were performed to identify risk factors associated with the development of PK.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      At the 1-year follow-up, the BLS group presented significantly greater vertebral height loss and kyphotic angle differences than did the NBLS group. Furthermore, the visual analog scale and Oswestry Disability Index scores were notably higher in the BLS group (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). The incidence of PK in the BLS group was 75.0% (39\/52), which was significantly greater than the 16.2% (21\/130) observed in the NBLS group (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). Cumulative event analysis revealed that a greater proportion of patients in the BLS group developed PK over the follow-up period. Both the log-rank test and Cox regression analysis demonstrated statistically significant differences (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). Multivariate regression analysis revealed that BLS was a significant independent risk factor for PK, with an odds ratio of 9.827 (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The black line sign on preoperative MR\u2013STIR images is a significant predictor of PK after PKP for OVCFs. Clinicians should consider closer monitoring, external bracing, and aggressive osteoporosis treatment for patients with BLS to reduce the risk of postoperative kyphotic deformities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40001-026-03898-9","type":"journal-article","created":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T12:19:21Z","timestamp":1768565961000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Preoperative black line sign predicts progressive kyphosis after percutaneous kyphoplasty in osteoporotic vertebral compression fractures"],"prefix":"10.1186","volume":"31","author":[{"given":"Lei","family":"He","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi","family":"Hong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhenan","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cong","family":"Jin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Feiyue","family":"Lin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,1,16]]},"reference":[{"issue":"4","key":"3898_CR1","doi-asserted-by":"publisher","first-page":"E383","DOI":"10.36076\/ppj.2024.7.E383","volume":"27","author":"D Liu","year":"2024","unstructured":"Liu D, Wen T, Li X, Xie Z, Wei M, Wang Y, et al. 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The study was approved by the Ethics Committee (full name: Ethics Committee of the Shaoxing People\u2019s Hospital, reference number NO2024SRP042-01), and informed consent was obtained from all patients.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interest"}}],"article-number":"278"}}