Construction and Validation of a Nomogram for Predicting the Risk of New Vertebral Fracture After Percutaneous Kyphoplasty in Osteoporotic Lumbar Vertebral Compression Fracture Patients Based on Lumbar Paraspinal Muscle Degeneration

Background: Percutaneous kyphoplasty (PKP) has been widely used for the treatment of osteoporotic vertebral compression fractures (OVCFs). However, the risk factors for refracture are controversial. Many studies have evaluated various factors; paraspinal muscle degeneration is one of them. Materials and Methods: This retrospective analysis was performed on 197 patients who underwent PKP for OLVCFs between July 2017 and December 2022. All patients were divided into the refracture group and the non-refracture group. Univariate logistic regression analysis was performed to determine whether there were differences in sex, age, body mass index (BMI), T-score, fatty infiltration (FI), relative cross-sectional area (rCSA), level of fracture vertebra, presence of lumbar spondylolisthesis, history of hypertension, or history of diabetes between the two groups. Multivariate logistic regression analysis was used to determine the independent risk factors for new vertebral fracture after PKP for OLVCFs, and a nomogram was constructed and validated to predict the risk of refracture. Results: The refracture rate was 21.8% (43/197). Univariate logistic regression analysis revealed statistically significant differences in age, BMI, T-score, and FI (all P < .1). Multivariate logistic regression analysis showed that the independent risk factors for new vertebral fracture were FI and T-score (all P < .05). The nomogram demonstrated favorable discriminative ability, with area under the curve values of 0.861 (95% CI: 0.793–0.928) in the training set and 0.796 (95% CI: 0.718–0.873) in the validation set ( P < .05, respectively). The decision curve analysis indicated satisfactory clinical utility. Conclusion: A higher FI of the lumbar paraspinal muscle and a lower T-score of the lumbar spine are independent risk factors for new vertebral fracture after PKP for OLVCFs. The nomogram established based on the risk factors demonstrated favorable predictive performance for refracture.