Development and validation of a prognostic model of vertebral refracture after percutaneous kyphoplasty

Abstract Purpose: To investigate the factors influencing refracture after percutaneous kyphoplasty and to develop and validate a prognostic model.Method: We retrospectively collected clinical data in 392 patients with osteoporotic vertebral compression fractures who underwent percutaneous kyphoplasty at the Affiliated Hospital of Xuzhou Medical University from 1 January 2018 to 1 January 2020.Predictors significantly associated with refracture after PKP were selected based on last absolute shrinkage and selection operator regression. Then a prognostic model were developed and internal validated using enhanced Bootstrap validation.Results: Among the 392 patients who included in this study, there were 19 refracture after percutaneous kyphoplasty(4.8%). Four factors were selected by least absolute shrinkage and selection operator regression for significant association with refracture after percutaneous kyphoplasty, including body mass index, bone mineral density, unilateral puncture, and bone cement leakage. After enhance Bootstrap validation, the bias-corrected curve of the model fitted well with the apparent curve, with the area under ROC curve of 0.931 and 95% CI of (0.789,0.936).Conclusion: The prognostic model developed based on four clinical profiles: body mass index, bone mineral density, unilateral puncture, and bone cement leakage can be used to identify those at most risk of refracture after percutaneous kyphoplasty.