A novel scoring system to predict the residual back pain after percutaneous kyphoplasty for osteoporotic vertebral compression fracture

Abstract

ObjectiveTo establish a scoring system to predict the residual back pain after percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fracture (OVCF).Materials and methodsWe retrospectively reviewed the clinical records of 98 patients who were diagnosed of single-vertebral OVCF and underwent PKP surgery in our department from January 2015 to December 2017. The following clinical characteristics including age, gender, disease course, fracture location, fracture type, segmental kyphosis, and bone cement volume were all recorded, and the effects of these factors on postoperative pain (at 1-month and 6-month postoperative) were also analyzed respectively. Based on 6-month postoperative VAS score, the included patients were divided into two groups, namely the residual back pain group (19 patients) and the non-residual back pain group (79 patients). The independent risk factors of residual back pain after PKP were screened and the scoring system was established by the multivariate logistic regression analysis. The performance of this scoring system was also prospectively validated using the clinical data of 45 patients with single-vertebral OVCF from January 2018 to December 2019.ResultsThe scoring system was consist of five clinical characteristics which were confirmed as significant predictors of residual back pain after PKP, namely, age ≥60 years (P = 0.021), fracture location = thoracic or lumbar (P = 0.002), fracture type = OF4 type (P = 0.018), segmental kyphosis ≥20° (P = 0.014), and bone cement volume <5 ml (P = 0.001). Patients in the residual back pain group showed a significant higher score than the non-residual back pain group (6.84 ± 1.71 vs. 2.66 ± 1.97, t = 8.499, P < 0.001), and the optimal cut-off value for the scoring system was 5 points. The sensitivity and specificity of the scoring system for predicting residual back pain after PKP were 84.21% and 87.34%, respectively, in derivation set and 78.57% and 83.87% in validation set.ConclusionThis novel scoring system showed satisfactory diagnostic efficacy in predicting residual back pain after PKP for single-vertebral OVCF. Patients with the score of 5–9 had a high risk of postoperative residual back pain, while the patients with score of 0–4 was low.

A Novel Imaging-Based Scoring System to Predict Progressive Kyphosis and Residual Back Pain Post-Percutaneous Kyphoplasty in Osteoporotic Vertebral Compression Fractures

“…In our study, we also found that Type D cement form, where the cement does not contact the upper and lower endplates, is a risk factor for residual lower back pain after surgery. Additionally, Yang reported that cement injection volume less than 5ml 13 , and Yu reported that cement injection volume less than 3ml 26 are risk factors for postoperative residual lower back pain, but in our study, we did not nd a correlation between cement injection volume and postoperative residual lower back pain. Moreover, we also found correlations between residual back pain and progressive kyphosis, the Spearman's rank correlation coe cient is 0.618.…”

“…The NIBSS score is also one of the important risk factors for residual lower back pain after surgery. Yang et al reported that kyphotic angle greater than 20 degrees and AO type A4 fractures are high-risk factors for residual lower back pain after surgery 13 . In the NIBSS scoring system, the larger the preoperative and postoperative kyphotic angles, the higher the score.…”

“…Similarly, the Genant and Magerl classi cations mainly emphasize morphological assessment of fractures, lacking a comprehensive evaluation of osteoporotic compression 11 . Yang also reported a new scoring system for predicting post-vertebroplasty residual lower back pain, which evaluates age, fracture location, fracture type, kyphotic angle, and cement injection volume among ve aspects 13 . However, this evaluation system is relatively complex with poor reproducibility.…”

“…Consistent with prior research, kyphosis angle difference exceeding 10 degrees at nal follow-up was classi ed as PK 12 . Additionally, a nal follow-up Visual Analog Scale (VAS) score surpassing 4 was designated as indicative of RBP 13 . Logistic regression analysis was employed to explore the association between PK and independent variables, as well as the relationship between RBP and various factors.…”

Comparison of the clinical effect of unilateral transverse process extrapedicular and bilateral transpedicular percutaneous kyphoplasty for thoracolumbar osteoporotic vertebral compression fracture

“…However, the drawbacks of transpedicular PKP have also been reported, including residual back pain, facet joint violation, and cement leakage. Yang et al reported that 19 of 98 patients with single-level OVCF who underwent PKP experienced residual back pain (VAS score >4 at 6 months postoperatively) ( 15 ). Similarly, Li et al conducted a study to analyze the risk factors of residual back pain in OVCF patients after PKP.…”