Multivariate analysis of poor relief of back pain after percutaneous vertebroplasty for thoracolumbar osteoporotic vertebral compression fracture

English Keywords:Osteoporotic vertebral compression fractures  Percutaneous vertebroplasty  Back pain  Risk factor  Multivariate analysis

English Abstract:

  【Abstruct】 Objectives: To explore the risk factors of poor relief of back pain(PRBP) after percutaneous vertebroplasty(PVP) in patients with thoracolumbar osteoporotic vertebral compression fractures(TOVCF). Methods: From March 2013 to March 2016, 1974 patients with TOVCF were treated by PVP in our Hospital. Factors that might have an influence on the efficacy of pain relief were evaluated, including demographic data(age, gender, height and weight), surgical and radiographic data and comorbidities. All patients were followed up at 1 week, 1 month, 3 months, and 1 year after operation, visual analogue scale(VAS) scores and Oswestry disability index(ODI) were recorded at each time point. We defined PRBP after PVP as VAS score >4 at both 1 week and 1 month after operation. According to the pain relief, the patients were divided into two groups, the satisfactory group and the unsatisfactory group. Results: Among 1974 patients, 81 cases complained PRBP, the prevalence was 4.1%. There was no significant difference of VAS score and ODI between the two group before operation and at 1 year after operation(P>0.05), while there were significant differences between the two group at 1 week, 1 month and 3 months after operation(P<0.05). Univariate analyses showed that there were significant differences of the preoperative bone mineral density(BMD), number of fractures, cement distribution and volume injected per level, the prevalence of thoracolumbar fascia injury preoperatively or at 1 month after operation, depression between these two groups respectively(P<0.05). Multivariate analysis revealed that pre-operative lower BMD[odds ratio(OR)=3.475, P=0.025], the existence of thoracolumbar fascia injury preoperatively or at 1 month after operation(OR=3.952, =0.003), higher number of fractures(OR=3.640, P<0.0001), unsatisfactory cement distribution(OR=3.216, P=0.016), insufficient cement volume injected per level(OR=0.081, P<0.0001), and depression(OR=3.616, P=0.014) were independently associated with PRBP after PVP at the early post-operative stage. Conclusions: pre-operative lower BMD, thoracolumbar fascia injury preoperatively or at 1 month after operation, higher number of vertebral fractures, unsatisfactory cement injected volume and distribution, depression were the risk factors of PRBP after PVP in patients with TOVCF.