Role of S₁ vertebral Hounsfield units value and bone quality score in predicting new vertebral compression fracture after percutaneous kyphoplasty.

Abstract

This study aimed to investigate the predictive performance of S₁ vertebral Hounsfield unit (HU) values and S₁ vertebral bone quality (VBQ) scores for new vertebral compression fractures (NVCF) after percutaneous kyphoplasty (PKP) in patients with osteoporotic vertebral compression fractures (OVCF). This retrospective analysis included patients who underwent PKP in our hospital from 2016 to 2024, categorizing them into non-NVCF and NVCF groups. The T₁₂-L₂ HU value, S₁ HU value, L₁-L₄ VBQ score, and S₁ VBQ score were collected from preoperative CT and MRI, respectively. Receiver operating characteristic (ROC) curve analysis was conducted to evaluate the predictive performance of these parameters. This study included 314 patients, of whom 107 (34.1%) developed NVCF during the follow-up period. Statistically significant differences in the T₁₂-L₂ HU value (P < 0.001), S₁ HU value (P < 0.001), L₁-L₄ VBQ score (P < 0.001), and S₁ VBQ score (P < 0.001) were observed between the two groups. Multivariable analysis revealed that NVCF was independently associated with T₁₂-L₂ HU value (OR = 0.96, 95% CI = 0.95-0.97, P < 0.001), S₁ HU value (OR = 0.98, 95% CI = 0.97-0.98, P < 0.001), L₁-L₄ VBQ score (OR = 2.24, 95% CI = 1.70-2.96, P < 0.001), and S₁ VBQ score (OR = 3.39, 95% CI = 2.36-4.48, P < 0.001). ROC analysis revealed an adjusted area under the curve (AUC) of 0.773 (optimal cut-off: 3.33; sensitivity: 79.4%; specificity: 56.0%) and 0.808 (optimal cut-off: 92.91; sensitivity: 80.7%; specificity: 66.4%) for the S₁ VBQ score and S₁ HU value, respectively. Furthermore, the adjusted AUC for the T₁₂-L₂ HU value and L₁-L₄ VBQ score were 0.825 and 0.773, respectively. The S₁ HU value and S₁ VBQ score were considered independent predictors of NVCF after PKP. The S₁ HU value is the most clinically useful indicator, the S₁ VBQ score serves as a supplementary indicator.