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

Osteoporotic vertebral compression fractures (OVCF) 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. We retrospectively analyzed patients who underwent PVA at three 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 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. Among the 483 patients, 52 (10.76%) developed adjacent vertebral refractures within two years. The nomogram demonstrated high predictive accuracy, with AUCs of 89.21% in the training set and 98.33% in the validation set. 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.