A Nomogram for Predicting the Residual Back Pain after Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures

Abstract

Objective. 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 postoperative 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 evaluate 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 ), severe 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.

The incidence and risk factors of lumbodorsal fasciitis in osteoporotic vertebral compression fractures: a retrospective study in 1182 cases

“…We showed for the rst time that concomitant lumbodorsal fasciitis was high as 45% in OVCF without previous spine surgery. As was reported previously patients with thoracolumbar fascia injury were on average older than those without fascia injury [13], an average age of 72.19 yrs old in this study might contribute to the higher global incidence of lumbodorsal fasciitis than in previous reports [3,15,16].…”

“…Based on the high incidence (45%) of fascia edema in OVCF and signi cant pain relief after vertebroplasty, lumbodorsal fasciitis was expected to cause mild and non-speci c pain in the lower back [20]. Thirdly, other related factors such as radiographic parameters of regional or global kyphosis [3,15], body mass index (BMI) [17], and quanti ed paravertebral muscle degeneration [17][18][19] were not evaluated to fully understand the promoter of fascia edema. Further prospective studies with strati ed participants and long-term follow-up are warranted for a better understanding of the risk factors and pathogenesis of lumbodorsal fasciitis.…”

“…Until recently, concomitant lumbodorsal fascia edema in OVCF has long been underestimated with a less uni ed diagnosis of posterior fascia oedema [3,15], thoracolumbar fascia injury [13,16], and lumbodorsal fascia contusion [14]. The reported incidence also varied signi cantly from 7% in 268 [3] to 50% in 120 OVCF cases [14]. To date, this was the rst study speci cally investigating its incidence and risk factors in a large study population of 1182 patients.…”

“…Osteoporotic vertebral compression fractures (OVCF) are the leading cause of back pain in ageing populations, affecting 1.4 million per year worldwide and causing high economic burdens [1,2]. On T2weighted fat suppression Magnetic Resonance (MR) imaging of spine, a fresh OVCF shows hyperintense signal indicating of vertebral bone marrow edema [3]. In some patients, an edema signal could also be detected subcutaneously dorsal to the thoracolumbar fascia, suggesting a comorbidity of lumbodorsal fasciitis in the OVCF [3][4][5].…”

“…On T2weighted fat suppression Magnetic Resonance (MR) imaging of spine, a fresh OVCF shows hyperintense signal indicating of vertebral bone marrow edema [3]. In some patients, an edema signal could also be detected subcutaneously dorsal to the thoracolumbar fascia, suggesting a comorbidity of lumbodorsal fasciitis in the OVCF [3][4][5]. While the epidemiology and pathogenesis of lumbodorsal fasciitis remain elusive, evidence accumulates that the lumbodorsal fascia is innervated with terminal nerves and could be a potential source of acute or chronic low back pain [6][7][8][9][10][11][12].…”