{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T18:57:43Z","timestamp":1791140263269,"version":"4.1.0"},"reference-count":24,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,2,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>The objective of this study was to evaluate the factors that affect refracture in the same cemented vertebra after percutaneous kyphoplasty (PKP) for K\u00fcmmell\u2019s disease (KD) and establish a risk prediction score.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>A total of 2932 patients who were treated with PKP for KD between January 2019 and December 2021 were retrospectively reviewed. After inclusion and exclusion criteria were applied, 191 patients were included in the study. According to the criteria for refracture, there were 50 patients in the refracture group and 141 patients in the no-refracture group. Twenty-five factors were analyzed. Patient demographics, medical history, imaging data, surgical data, and postoperative management were reviewed. Multivariate logistic regression modeling was used to identify the independent risk factors for refracture. Receiver operating characteristic (ROC) curve analysis was used to assess and establish a risk score system and further predict the risk of refracture.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>In this study, 50 (26.2%) patients developed a refracture. Through univariate analysis, bone mineral density (BMD) (p &lt; 0.001), compression rate (p = 0.007), classification (i.e., the stages determined by the compression ratios) (p &lt; 0.001), bone cement volume (p &lt; 0.001), volume fraction (p &lt; 0.001), distribution pattern (p = 0.007), non-PMMA endplate contact (p &lt; 0.001), and anti-osteoporosis therapy (p &lt; 0.001) were found to be significant factors for post-cement vertebral refracture after PKP in patients with KD. Three independent risk factors were found to be significant for refracture: small volume fraction, low BMD, and no anti-osteoporosis therapy. One point was assigned for each factor. The incidence rates of refracture in patients with scores of 0, 1, 2, and 3 were 3.7%, 4.4%, 42.0%, and 100%, respectively. The area under the ROC curve for this risk prediction score was 0.888 (p &lt; 0.001), indicating moderate accuracy.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Volume fraction, BMD, and osteoporosis therapy are the main factors influencing the refracture of the same cemented vertebra in KD. On the basis of these factors, the risk prediction score developed in this paper can be used to forecast the incidence of refracture.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.8.spine23498","type":"journal-article","created":{"date-parts":[[2023,11,11]],"date-time":"2023-11-11T01:56:49Z","timestamp":1699667809000},"page":"255-264","source":"Crossref","is-referenced-by-count":7,"title":["Risk factor analysis of refracture in the same cemented vertebra after percutaneous kyphoplasty for K\u00fcmmell\u2019s disease"],"prefix":"10.3171","volume":"40","author":[{"given":"Tangyiheng","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, China;"},{"name":"Departments of Orthopaedic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Genglei","family":"Chu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, China;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yimeng","family":"Qu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, China;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yujie","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, China;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, China;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nan","family":"Hu","sequence":"additional","affiliation":[{"name":"Nephrology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huilin","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, China;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuefeng","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, China;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weimin","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, China;"},{"name":"Departments of Orthopaedic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yijie","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, China;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"2","key":"b1","series-title":"Eur J Orthop Surg Traumatol","first-page":"309","article-title":"Case report of Kummell\u2019s disease with delayed onset myelopathy and the literature review","volume":"28","author":"D\u2019Oria S","year":"2018","unstructured":"D\u2019Oria S, Delvecchio C, Dibenedetto M, Zizza F, Somma C. Case report of Kummell\u2019s disease with delayed onset myelopathy and the literature review. Eur J Orthop Surg Traumatol. 2018;28(2):309\u2013316."},{"issue":"1","key":"b2","series-title":"BMC Musculoskelet Disord","first-page":"10","article-title":"Analysis of the effect of percutaneous vertebroplasty in the treatment of thoracolumbar K\u00fcmmell\u2019s disease with or without bone cement leakage","volume":"22","author":"Xiao YP","year":"2021","unstructured":"Xiao YP, Bei MJ, Yan CQ, Chang JZ. Analysis of the effect of percutaneous vertebroplasty in the treatment of thoracolumbar K\u00fcmmell\u2019s disease with or without bone cement leakage. BMC Musculoskelet Disord. 2021;22(1):10."},{"issue":"1","key":"b3","series-title":"Radiology","first-page":"23","article-title":"The intravertebral vacuum cleft: a sign of ischemic vertebral collapse","volume":"129","author":"Maldague BE","year":"1978","unstructured":"Maldague BE, Noel HM, Malghem JJ. The intravertebral vacuum cleft: a sign of ischemic vertebral collapse. Radiology. 1978;129(1):23\u201329."},{"issue":"1 suppl","key":"b4","series-title":"J Neurosurg","first-page":"21","article-title":"Percutaneous vertebroplasty and kyphoplasty for painful vertebral body fractures in cancer patients","volume":"98","author":"Fourney DR","year":"2003","unstructured":"Fourney DR, Schomer DF, Nader R,  Percutaneous vertebroplasty and kyphoplasty for painful vertebral body fractures in cancer patients. J Neurosurg. 2003;98(1 suppl):21\u201330."},{"issue":"7","key":"b5","series-title":"Arch Orthop Trauma Surg","first-page":"927","article-title":"Repeated percutaneous vertebroplasty for refracture of cemented vertebrae","volume":"131","author":"Chen LH","year":"2011","unstructured":"Chen LH, Hsieh MK, Liao JC,  Repeated percutaneous vertebroplasty for refracture of cemented vertebrae. Arch Orthop Trauma Surg. 2011;131(7):927\u2013933."},{"issue":"3","key":"b6","series-title":"Osteoporos Int","first-page":"473","article-title":"Recollapse of previous vertebral compression fracture after percutaneous vertebroplasty","volume":"20","author":"Heo DH","year":"2009","unstructured":"Heo DH, Chin DK, Yoon YS, Kuh SU. Recollapse of previous vertebral compression fracture after percutaneous vertebroplasty. Osteoporos Int. 2009;20(3):473\u2013480."},{"issue":"11","key":"b7","series-title":"Eur Spine J","first-page":"1907","article-title":"Recompression of vertebral body after balloon kyphoplasty for osteoporotic vertebral compression fracture","volume":"19","author":"Kim YY","year":"2010","unstructured":"Kim YY, Rhyu KW. Recompression of vertebral body after balloon kyphoplasty for osteoporotic vertebral compression fracture. Eur Spine J. 2010;19(11):1907\u20131912."},{"issue":"6","key":"b8","series-title":"Ann Rehabil Med","first-page":"844","article-title":"Predictive risk factors for refracture after percutaneous vertebroplasty","volume":"35","author":"Kang SK","year":"2011","unstructured":"Kang SK, Lee CW, Park NK,  Predictive risk factors for refracture after percutaneous vertebroplasty. Ann Rehabil Med. 2011;35(6):844\u2013851."},{"issue":"2","key":"b9","series-title":"Pain Physician","first-page":"E221","article-title":"Minding the gap in vertebroplasty: vertebral body fracture clefts and cement nonunion","volume":"24","author":"Tomas C","year":"2021","unstructured":"Tomas C, Jensen A, Ahmed F, Ho CK, Jesse MK. Minding the gap in vertebroplasty: vertebral body fracture clefts and cement nonunion. Pain Physician. 2021;24(2):E221\u2013E230."},{"issue":"9","key":"b10","series-title":"J Bone Miner Res","first-page":"1137","article-title":"Vertebral fracture assessment using a semiquantitative technique","volume":"8","author":"Genant HK","year":"1993","unstructured":"Genant HK, Wu CY, van Kuijk C, Nevitt MC. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res. 1993;8(9):1137\u20131148."},{"issue":"1","key":"b11","series-title":"J Musculoskelet Res","first-page":"43","article-title":"Staging of K\u00fcmmell\u2019s disease","volume":"8","author":"Li KC","year":"2004","unstructured":"Li KC, Wong TU, Kung FC, Li A, Hsieh CH. Staging of K\u00fcmmell\u2019s disease. J Musculoskelet Res. 2004;8(1):43\u201355."},{"key":"b12","series-title":"Int J Gen Med","first-page":"6199","article-title":"Percutaneous kyphoplasty in patients with severe osteoporotic vertebral compression fracture with and without intravertebral cleft: a retrospective comparative study","volume":"15","author":"Liu H","year":"2022","unstructured":"Liu H, Zhou Q, Shao X,  Percutaneous kyphoplasty in patients with severe osteoporotic vertebral compression fracture with and without intravertebral cleft: a retrospective comparative study. Int J Gen Med. 2022;15:6199\u20136209."},{"issue":"6","key":"b13","series-title":"Eur Spine J","first-page":"901","article-title":"Conversion to hypertrophic vertebral pseudarthrosis following percutaneous vertebroplasty","volume":"19","author":"Kawaguchi S","year":"2010","unstructured":"Kawaguchi S, Horigome K, Yajima H,  Conversion to hypertrophic vertebral pseudarthrosis following percutaneous vertebroplasty. Eur Spine J. 2010;19(6):901\u2013906."},{"key":"b14","series-title":"World Neurosurg","first-page":"e430","article-title":"Does the relationship between bone cement and the intravertebral cleft of Kummell disease affect the efficacy of PKP?","volume":"160","author":"Lv NN","year":"2022","unstructured":"Lv NN, Hou MZ, Zhou ZZ,  Does the relationship between bone cement and the intravertebral cleft of Kummell disease affect the efficacy of PKP? World Neurosurg. 2022;160:e430\u2013e435."},{"issue":"7","key":"b15","series-title":"Eur Spine J","first-page":"982","article-title":"Revision strategies for complications and failure of vertebroplasties","volume":"17","author":"Yang SC","year":"2008","unstructured":"Yang SC, Chen WJ, Yu SW, Tu YK, Kao YH, Chung KC. Revision strategies for complications and failure of vertebroplasties. Eur Spine J. 2008;17(7):982\u2013988."},{"key":"b16","series-title":"BioMed Res Int","first-page":"2193895","article-title":"Comparison between percutaneous kyphoplasty and posterior fixation combined with vertebroplasty in the treatment of stage III K\u00fcmmell\u2019s disease without neurological deficit","volume":"2022","author":"Liu Y","year":"2022","unstructured":"Liu Y, Zhu Y, Li R, Jiang W, Yang H. Comparison between percutaneous kyphoplasty and posterior fixation combined with vertebroplasty in the treatment of stage III K\u00fcmmell\u2019s disease without neurological deficit. BioMed Res Int. 2022;2022:2193895."},{"issue":"14","key":"b17","series-title":"Spine (Phila Pa 1976)","first-page":"1549","article-title":"The effect of vertebral body percentage fill on mechanical behavior during percutaneous vertebroplasty","volume":"28","author":"Molloy S","year":"2003","unstructured":"Molloy S, Mathis JM, Belkoff SM. The effect of vertebral body percentage fill on mechanical behavior during percutaneous vertebroplasty. Spine (Phila Pa 1976). 2003;28(14):1549\u20131554."},{"issue":"18","key":"b18","series-title":"Spine (Phila Pa 1976)","first-page":"E505","article-title":"Effect of bone density on vertebral strength and stiffness after percutaneous vertebroplasty","volume":"32","author":"Graham J","year":"2007","unstructured":"Graham J, Ahn C, Hai N, Buch BD. Effect of bone density on vertebral strength and stiffness after percutaneous vertebroplasty. Spine (Phila Pa 1976). 2007;32(18):E505\u2013E511."},{"issue":"4","key":"b19","series-title":"J Clin Neurosci","first-page":"509","article-title":"Cement augmented anterior reconstruction with short posterior instrumentation: a less invasive surgical option for Kummell\u2019s disease with cord compression","volume":"18","author":"Lee SH","year":"2011","unstructured":"Lee SH, Kim ES, Eoh W. Cement augmented anterior reconstruction with short posterior instrumentation: a less invasive surgical option for Kummell\u2019s disease with cord compression. J Clin Neurosci. 2011;18(4):509\u2013514."},{"issue":"8","key":"b20","series-title":"Clin Neurol Neurosurg","first-page":"678","article-title":"Osteoporotic burst fracture with spinal canal compromise treated with percutaneous vertebroplasty","volume":"112","author":"Li CH","year":"2010","unstructured":"Li CH, Chang MC, Liu CL, Chen TS. Osteoporotic burst fracture with spinal canal compromise treated with percutaneous vertebroplasty. Clin Neurol Neurosurg. 2010;112(8):678\u2013681."},{"issue":"2","key":"b21","series-title":"Int Orthop","first-page":"359","article-title":"The therapeutic effects of percutaneous kyphoplasty on osteoporotic vertebral compression fractures with or without intravertebral cleft","volume":"43","author":"Li Z","year":"2019","unstructured":"Li Z, Liu T, Yin P,  The therapeutic effects of percutaneous kyphoplasty on osteoporotic vertebral compression fractures with or without intravertebral cleft. Int Orthop. 2019;43(2):359\u2013365."},{"key":"b22","series-title":"Front Surg","first-page":"1061498","article-title":"A mid- and long-term follow-up study on the bilateral pedicle anchoring technique with percutaneous vertebroplasty for the treatment of K\u00fcmmell\u2019s disease","volume":"10","author":"Dai S","year":"2023","unstructured":"Dai S, Du Y, Chen L, Xu Y, Hu Q. A mid- and long-term follow-up study on the bilateral pedicle anchoring technique with percutaneous vertebroplasty for the treatment of K\u00fcmmell\u2019s disease. Front Surg. 2023;10:1061498."},{"issue":"7","key":"b23","series-title":"J Vasc Interv Radiol","first-page":"1017","article-title":"Percutaneous vertebroplasty in very severe osteoporotic vertebral compression fractures: feasible and beneficial","volume":"22","author":"Nieuwenhuijse MJ","year":"2011","unstructured":"Nieuwenhuijse MJ, van Erkel AR, Dijkstra PD. Percutaneous vertebroplasty in very severe osteoporotic vertebral compression fractures: feasible and beneficial. J Vasc Interv Radiol. 2011;22(7):1017\u20131023."},{"issue":"5","key":"b24","series-title":"Clin Sci (Lond)","first-page":"537","article-title":"Vertebral bone loss: an unheeded side effect of therapeutic bed rest","volume":"64","author":"Kr\u00f8lner B","year":"1983","unstructured":"Kr\u00f8lner B, Toft B. Vertebral bone loss: an unheeded side effect of therapeutic bed rest. 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