Spine (Phila Pa 1976). 2025 Jul 1. doi: 10.1097/BRS.0000000000005444. Online ahead of print.ABSTRACTSTUDY DESIGN: Retrospective study.OBJECTIVE: To verify the association between pedicle enhancement (PE) on contrast-enhanced magnetic resonance imaging (MRI) and progressive collapse, and analyze the correlation between the degree of PE and progressive collapse.SUMMARY OF BACKGROUND DATA: Osteoporotic compression fracture (OCF) is generally considered a stable fracture, with most patients achieving successful recovery through conservative treatment such as bracing and physical therapy. However, in some cases, progressive collapse occurs, requiring additional treatment or surgery.METHODS: We enrolled 203patitents and analyzed factors related to progressive collapse. We evaluated the association between PE and progressive collapse and determined the best cult off value of the signal-to-noise ratio of PE (SNR of PE) for predicting progressive collapse. Survival analysis using Kaplan-Meier curve was performed to assess the cumulative risk of positive progressive collapse over time.RESULTS: Presence of PE, SNR of PE, age, body mass index, and segmental kyphosis were significantly correlated with progressive collapse. The optimal cutoff point of SNR of PE was measured at 89.3 with 71.1% and 78.7% sensitivity and specificity, respectively, with an AUC of 0.781. Analysis of cumulative progressive collapse incidence revealed a significant difference between the PE and NPE groups within 1-2 months after OCF, which stabilized after three months.CONCLUSIONS: PE is a significant predictor of progressive collapse in OCF within a year, aiding spine surgeons in risk assessment of progressive collapse and management of acute OCF.LEVEL OF EVIDENCE: 3.PMID:40590204 | DOI:10.1097/BRS.0000000000005444