Incidence and predictors of residual back pain after percutaneous vertebral augmentation in osteoporotic vertebral compression fracture: a systematic review and meta analysis.

Abstract

The incidence and predictors of residual back pain (RBP) following percutaneous vertebral augmentation (PVA) in osteoporotic vertebral compression fractures (OVCFs) remain unclear. This review aims to clarify these factors to guide clinical practice and enhance patient outcomes. Four English and three Chinese databases were systematically searched from their inception until June 1, 2024. Data were analyzed using Stata 16.0. Incidence rates of RBP were pooled from all included studies, and predictors identified in two or more studies were aggregated. Sensitivity analyses were conducted for stability and reliability. Meta-regression and subgroup analyses were conducted to explore the causes of heterogeneity, while Begg, Egger test, and funnel plots were used to assess publication bias. This meta-analysis included 27 studies with a total of 8,806 patients, found that the incidence rate of RBP in patients with OVCFs after PVA was 24.4% (95% CI: 19.5-29.3%). Seventeen predictors for RBP were identified, which included demographic and personal history factors, injury characteristics, and bone cement and postoperative factors. The most frequent predictor was low preoperative bone density (OR = 2.208, 95% CI: 2.018-2.415, p < 0.001), followed by thoracolumbar fascia injury (OR = 3.875, 95% CI: 2.752-5.457, p < 0.001) and maldistribution of bone cement (OR = 2.065, 95% CI: 1.728-2.467, p < 0.001). Fifteen risk factors and two protective factors for RBP were identified. These findings highlight the importance of thorough preoperative assessment and meticulous surgical technique in reducing the risk of RBP in patients with OVCFs undergoing PVA. This study conducted a systematic review and meta-analysis to explore the incidence and predictors of residual back pain (RBP) in patients with osteoporotic vertebral compression fractures (OVCFs) who had underwent percutaneous vertebral augmentation (PVA).The findings identified a total of fifteen risk factors and two protective factors associated with RBP. Specifically, low preoperative bone density, thoracolumbar fascia injury, and maldistribution of bone cement were revealed to be the most common predictors.