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• W3141337170 abstract "To the Editor: We read with great interest the article by Chiu et al1 on the potential risk factors for sandwich vertebral fractures in Neurosurgery. The authors performed a retrospective analysis of the largest sample of 1347 patients undergoing cement augmentation for osteoporotic vertebral compression fracture (VCFs). They found that the incidence of sandwich vertebral fractures was about 21.3%, most occurred within 2 yr, and was lower than that of adjacent vertebral fractures, with men being the only risk factor for their occurrence. This is a very interesting study that will help in the development of subsequent clinical treatment plans. However, we would still like to share some of these issues with the authors and also provide some suggestions. First, we note that the authors performed the statistical analysis without multivariate adjustment and did not perform a subgroup analysis to separately identify risk factors for sandwich vertebral fractures. This is because sandwich vertebral fractures may have different characteristics in different subgroups. For example, it has been reported that2,3 because of the difference in cement interface distribution between percutaneous vertebroplasty (VP) and balloon kyphoplasty (KP), the postoperative reduction in vertebral body height is more pronounced in KP than in VP. However, the authors did not compare the subgroups of VP/KP patients separately in their statistical analysis, which may compromise the reliability and accuracy of the results. Moreover, other risk factors that influence recurrent fractures in patients with VP/KP may also bias the results. For example, the number of vertebrae fractured, the number of vertebrae in VP/KP, and antiosteoporotic therapy are all associated with recurrent fractures.4 Second, in the present study, the authors used new onset back pain, reduced vertebral height, or new vertebral fractures in postoperative patients as a diagnosis of sandwich vertebral fracture and used Kaplan-Meier Survival Analysis with the log-rank test in their statistical analysis to derive risk factors. However, new VCFs after VP/KP are not uncommon and have been reported that there are strong risk factors associated with their occurrence.5,6 Therefore, we suggest that statistics on the time from postoperative period to event onset, defining this important data as asymptomatic survival, may provide valuable guidance for optimal follow-up time and may help patients’ clinical management. At the same time, according to several previous studies,7-9 the use of Cox proportional hazard model may yield more reliable and statistically valid results. Finally, we recommend the inclusion of the indicator of change in vertebral body height before and after VP/KP, as there are several reports10,11 that the restoration of fractured vertebral body height increases the risk of adjacent vertebral fractures. An increase in fractured vertebral body height may increase soft tissue tension in other vertebrae, disruption of normal spinal biomechanics, and excessive vertebral body stress loading, leading to new adjacent vertebral body fractures. Besides, the characteristics of vertebral body fractures may also be associated with recurrent fractures, eg, patients with intravertebral fractures are more than twice as likely to have a postoperative recurrent fracture as patients with nonintravertebral fractures, which may increase the risk of new fractures because of the formation of a confined mass of bone cement within the fracture, which increases the stiffness of the vertebral body and disrupts the mechanism of uniform distribution of vertebral body stress.12 If there is an endplate fracture of the vertebral body, it may change the central depression of the vertebral body's endplate, thereby increasing the intervertebral pressure, resulting in a relative concentration of stress that compresses the intervertebral disc and transmits stress to the adjacent vertebral endplate and vertebral body, resulting in a recurrent fracture, which is also consistent with previous reports.13 In summary, because of the aging of the population and the widespread use of VP/KP, it is important to seek a clearer picture of the risk factors for recurrent fractures after VP/KP. We believe that future well-designed prospective studies and large sample data will contribute to further understanding of dissection vertebral fractures. Funding This work was supported by the National Natural Science Foundation of China (81802211 to Dr Wang and 81871821 to Dr Li). Disclosures The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article." @default.
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• W3141337170 date "2021-03-17" @default.
• W3141337170 modified "2023-10-18" @default.
• W3141337170 title "Letter: A Retrospective Analysis in 1347 Patients Undergoing Cement Augmentation for Osteoporotic Vertebral Compression Fracture: Is the Sandwich Vertebra at a Higher Risk of Further Fracture?" @default.
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• W3141337170 doi "https://doi.org/10.1093/neuros/nyab067" @default.
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