椎体压缩骨折（VCF）是脊柱立体定向放射治疗（SBRT）常见但严重的毒性反应。先前已经确定了使患者处于 VCF 高风险的几个变量，包括高级脊柱不稳定性肿瘤评分 (SINS)，这是一种广泛采用的评估脊柱不稳定性的临床决策标准。我们研究了肿瘤终板 (EP) 破坏在 VCF 风险中的作用，并尝试将其纳入简单的风险分层系统。本研究是来自单个机构的回顾性队列研究。收集了 2013 年至 2019 年间接受脊柱 SBRT 的患者的人口统计和治疗信息。在 SBRT 前计算机断层扫描中发现 EP 中断。主要终点为 VCF 1 年累积发生率，通过治疗后每隔 3 个月进行的随访 MRI 和计算机断层扫描进行评估。总共纳入 111 名患者。中位随访时间为 18 个月。大约 48 名患者 (43%) 至少经历过一次 EP 中断。 20 名患者 (18%) 在 SBRT 后平均 5.2 个月内经历了 VCF。至少有一次 EP 中断的患者比没有 EP 中断的患者更有可能经历 VCF（29% vs 6%，P < .001）。使用 EP 破坏、SINS ≥7 和不良组织学等变量创建列线图。将患者分为 VCF 低风险组和高风险组，分别与 2% 和 38% VCF 风险相关 (P < .001)。EP 中断是接受脊柱 SBRT 患者发生 VCF 的新危险因素。结合 EP 破坏、不良组织学和 SINS 评分的简单列线图可有效快速评估 VCF 风险。这些数据需要在前瞻性研究中进行验证，并且可能有助于向患者提供有关 VCF 风险的咨询，并转诊高危人群的预防性干预措施。版权所有 © 神经外科医生大会 2023。保留所有权利。

Vertebral compression fracture (VCF) is a common, but serious toxicity of spinal stereotactic body radiotherapy (SBRT). Several variables that place patients at high risk of VCF have previously been identified, including advanced Spinal Instability Neoplastic Score (SINS), a widely adopted clinical decision criterion to assess spinal instability. We examine the role of tumoral endplate (EP) disruption in the risk of VCF and attempt to incorporate it into a simple risk stratification system.This study was a retrospective cohort study from a single institution. Demographic and treatment information was collected for patients who received spinal SBRT between 2013 and 2019. EP disruption was noted on pre-SBRT computed tomography scan. The primary end point of 1-year cumulative incidence of VCF was assessed on follow-up MRI and computed tomography scans at 3-month intervals after treatment.A total of 111 patients were included. The median follow-up was 18 months. Approximately 48 patients (43%) had at least one EP disruption. Twenty patients (18%) experienced a VCF at a median of 5.2 months from SBRT. Patients with at least one EP disruption were more likely to experience VCF than those with no EP disruption (29% vs 6%, P < .001). A nomogram was created using the variables of EP disruption, a SINS of ≥7, and adverse histology. Patients were stratified into groups at low and high risk of VCF, which were associated with 2% and 38% risk of VCF (P < .001).EP disruption is a novel risk factor for VCF in patients who will undergo spinal SBRT. A simple nomogram incorporating EP disruption, adverse histology, and SINS score is effective for quickly assessing risk of VCF. These data require validation in prospective studies and could be helpful in counseling patients regarding VCF risk and referring for prophylactic interventions in high-risk populations.Copyright © Congress of Neurological Surgeons 2023. All rights reserved.