A nomogram for predicting the residual back pain after percutaneous vertebroplasty for osteoporotic vertebral compression fractures

Abstract

Background: Current findings suggest that percutaneous vertebroplasty(PVP) is a suitable therapeutic approach for osteoporotic vertebral compression fractures (OVCFs). However, a significant minority of patients still experience residual back pain after PVP. The present retrospective study was designed to determine the risk factors for residual back pain after PVP and provides a nomogram for predicting the residual back pain after PVP.Methods: We retrospectively reviewed the medical records of patients with single-segment OVCFs who underwent bilateral percutaneous vertebroplasty. Patients were divided into group N and group R according to the postoperative VAS score. Group R is described as the VAS score of residual back pain≥4. Pre- and post-operative factors that may affect back pain relief were evaluated between two groups. Univariate and multivariate logistic regression analysis were performed to identify risk factors affecting residual back pain after PVP. We provided a nomogram for predicting the residual back pain and used the receiver operating characteristic curve (ROC), concordance index (c-index), calibration curve, and decision curve analyses(DCA) to evaluated the prognostic performance.Results: Among 268 patients treated with PVP, 37(13.81%) patients were classified postoperative residual back pain.The results of the multivariate logistical regression analysis showed that the presence of an intravertebral vacuum cleft(IVC)(OR 3.790, P=0.026), posterior fascia oedema(OR 3.965, P=0.022), server paraspinal muscle degeneration(OR 5.804, P=0.01; OR 13.767,P<0.001) and blocky cement distribution(OR 2.225, P=0.041) were independent risk factors for residual back pain after PVP. The AUC value was 0.780, suggesting that the predictive ability was excellent. The prediction nomogram presented good discrimination, with a C-index of 0.774(0.696~0.852), and was validated to be 0.752 through bootstrapping validation. The calibration curve of the nomogram demonstrated a good consistency between the probabilities predicted by the nomogram and the actual probabilities. The nomogram showed net benefits in the range from 0.06 to 0.66 in DCA.Conclusions: The presence of IVC, posterior fascia oedema, blocky cement distribution and severe paraspinal muscle degeneration were significant risk factors for residual back pain after PVP for OVCFs. Patients with OVCFs after PVP who have these risk factors should be carefully monitored for the possible development of residual back pain. We provide a nomogram for predicting the residual back pain after PVP.

Development and Internal Validation of Supervised Machine Learning Algorithm for Predicting the Risk of Recollapse Following Minimally Invasive Kyphoplasty in Osteoporotic Vertebral Compression Fractures

“…A long-standing perception of IVC as a sign of instability may be a consequence of the fibrocartilaginous membrane surrounding the IVC, which prevents cement diffusion and observes an unsatisfactory bonding between the cement and the surrounding cancellous bone ( 34 ). Thus, it is logically a sign of surgical complications including recollapse and residual low back pain ( 35 , 36 ). Yu et al systematically reviewed substantial studies and summarily reported a significant therapeutic efficacy in OVCF patients with percutaneous vertebral augmentation, but IVC was responsible for more frequent recollapse and unfavorable radiological parameters compared to controls ( 37 ).…”

Research Progress of Paraspinal Muscle Fat Infiltration in Osteoporotic Vertebral Compression Fractures

“…Paraspinal muscle fat infiltration is closely related to low back pain. Li et al [42] retrospectively analyzed 268 patients who underwent PVP treatment for OVCFs and found that residual low back pain after surgery was closely related to severe paraspinal degeneration. Li et al [43] analyzed the correlation between the degree of paraspinal muscle atrophy and spinal-pelvic parameters in 39 patients with OVCFs and suggested that as paraspinal muscle fat infiltration increases, pelvic degeneration also occurs, and even lumbar lordosis is affected.…”