Development and Validation of a Nomogram for Predicting Adjacent Vertebral Fracture After Osteoporotic Vertebral Compression Fracture Surgery: A Multicenter Retrospective Cohort Study.

Objective: Osteoporotic vertebral compression fractures (OVCFs) are a major public health concern. While percutaneous vertebral augmentation (PVA) is an effective treatment for OVCF, adjacent vertebral fractures (AVF) often occur post-PVA, adversely affecting treatment outcomes. This study aims to develop a nomogram for predicting AVF risk using multicenter data to aid clinical decision-making for OVCF patients.

Methods: We retrospectively analyzed patients who underwent PVA at 3 hospitals between 2017 and 2022. The cohort was divided into a training set (80%) and a validation set (20%). Independent risk factors for AVF were identified using LASSO (least absolute shrinkage and selection operator) and logistic regression. Seven significant factors were: bone mineral density, diabetes, total fractured vertebrae, intravertebral vacuum cleft sign, recovery of local kyphosis angle, regular aerobic exercise, and lumbar brace use.

Results: Among the 483 patients, 52 (10.76%) developed adjacent vertebral refractures within 2 years. The nomogram demonstrated high predictive accuracy, with area under the curves of 89.21% in the training set and 98.33% in the validation set.

Conclusion: This pioneering nomogram, incorporating baseline, surgical, and postoperative factors, provides valuable guidance for spine surgeons in preoperative planning and postoperative management, enabling personalized prognosis and rehabilitation for OVCF patients.