Prevalence and risk factors for residual back pain after percutaneous vertebral augmentation in osteoporotic vertebral compression fracture patients: a systematic review and meta-analysis.

Abstract

Objective: The purpose of this study was to evaluate the occurrence and potential causes of residual back pain following percutaneous vertebral augmentation (percutaneous vertebroplasty/percutaneous kyphoplasty) in patients with osteoporotic vertebral compression fracture.

Methods: To investigate the occurrence and risk factors of residual back pain, a comprehensive search was conducted in several databases including PubMed, Web of Science, Embase, Cochrane Library, China Knowledge Resource Integrated Database (CNKI), Chinese Biomedical Database (CBM), Wanfang Database, and Weipu Database (VIP) from the inception until October 10, 2023. After applying inclusion and exclusion criteria, the articles were filtered. The quality of the included studies was assessed independently by two investigators. Stata18.0 was used for the meta-analysis.

Results: In total, 1900 articles were screened, and data from 13 studies was used in the meta-analysis. After percutaneous vertebral augmentation for patients with osteoporotic vertebral compression fracture, the occurrence of residual back pain was 19% (95% confidence interval 14-23%, I ² = 96.6%, P < 0.001). The risk of residual back pain was increased by lower bone mineral density (OR = 5.56, 95%CI 3.83-8.09, P < 0.001), presence of intravertebral vacuum cleft (OR = 3.52, 95% CI 2.07-6.01, P < 0.001), unsatisfactory distribution of bone cement (OR = 2.79, 95% CI 2.05-3.81, P < 0.001), occurrence of recurrent fracture (OR = 4.34, 95%CI 2.75-6.84, P < 0.001), thoracolumbar fascia injury (OR = 3.21, 95% CI 1.91-5.40, P < 0.001), inadequate volume of bone cement injection (OR = 5.58, 95% CI 1.97-15.84, P = 0.001), and nonunion of fracture (OR = 4.67, 95%CI 2.00-10.88, P < 0.001). Furthermore, the rate of recovery in vertebral height (OR = 0.52 (95%CI 0.32-0.85, P = 0.009) may serve as a protective element.

Conclusion: There was a 19% prevalence of residual back pain among osteoporotic vertebral compression fracture patients with percutaneous vertebral augmentation. Patients with osteoporotic vertebral compression fracture may experience residual back pain after percutaneous vertebral augmentation due to a combination of intravertebral vacuum cleft, unsatisfactory bone cement distribution, recurrent fracture, thoracolumbar fascia injury, insufficient bone cement injection volume, fracture nonunion, bone mineral density, and vertebral height recovery rate.