Skewed bone cement distribution, a high proportion of bone cement volume to vertebral body volume and abnormal BMD is considered as the significant risk factors to cause SNVCF as per the reports a recently published analysis. Secondary new vertebral compression fractures (SNVCFs) involved two types of fractures; adjacent vertebral compression fractures (AVCFs) and remote vertebral compression fractures.

A total of 402 patients were assessed over a minimum follow-up of 4 years after PVP to extract data regarding the relationship of SNVCFs with radiological, clinical and PVP procedure-associated morphologic parameters. A three-dimensional voxel-based analysis was applied to evaluate the procedure-associated morphologic parameters. Multivariate and univariate regression analyses were directed. On univariate analysis, both AVCF and SNVCF showed a significant relationship with preoperative sagittal index (SI), bone mineral density (BMD), intradiscal bone cement leakage, and preoperative compression ratio, whereas, remote vertebral compression fracture only correlated with preoperative SI and BMD. Skewed bone cement distribution along the inferior-to-superior axis and a large proportion of bone cement volume to vertebral body volume considered as the significant risk factors for AVCF. On multivariate analysis, AVCF showed considerable correlation with upper adjacent intradiscal bone cement leakage and SNVCF with BMD. As per the findings, low BMD, high preoperative compression ratio, and high preoperative SI are the factors used to predict the SNVCF. The bone cement should be injected symmetrically and evenly through the inferior-to-superior axis, and the volume of relative bone cement should not be excessive to avoid upper adjacent intradiscal leakage. BMD correction should also be considered as an essential aspect to control SNVCF.