Degenerative scoliosis may trigger higher incidence of adjacent vertebral fractures following percutaneous vertebroplasty: a clinical evidence-based biomechanical research.

Abstract

Degenerative scoliosis can increase stress on nearby vertebrae after vertebroplasty, raising the risk of new fractures. Our clinical and biomechanical findings show that patients with scoliosis are more vulnerable, highlighting the need for closer monitoring and preventive strategies in this high-risk group. Adjacent vertebral fracture (AVF) is a common complication following percutaneous vertebroplasty (PVP). Degenerative scoliosis (DS), a manifestation of spinal degeneration, frequently occurs in elderly patients with osteoporotic vertebral compression fractures (OVCF). However, whether local DS increases AVF incidence remains unclear. On immediate postoperative anterior-posterior radiographs, the scoliosis angle was measured between adjacent cranial and caudal vertebrae. DS was defined as a scoliosis angle > 10°. We compared this angle and DS incidence between patients with and without AVF, performed regression analyses to identify AVF risk factors, and calculated stress values in vertebrae adjacent to PVP-treated levels using biomechanical models with varying scoliosis angles. Patients with AVF exhibited significantly larger scoliosis angles and higher DS incidence than those without AVF. Both parameters were independent risk factors for AVF. Biomechanical models with pronounced scoliosis showed markedly higher stress in adjacent vertebrae under most loading conditions compared to non-scoliotic or mildly scoliotic models. Supported by consistent clinical and biomechanical evidence, DS is associated with a higher incidence of AVF, likely due to biomechanical factors, and patients with DS should be considered high-risk after PVP.