Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China; Department of Orthopedics, Tenth People's Hospital Affiliated To Tongji University, Tongji University School of Medicine, Shanghai, China.
Pain Physician. 2021 May;24(3):E349-E356.
In clinical practice, we have found that the pain caused by thoracolumbar osteoporotic vertebral compression fracture (OVCF) is sometimes not limited to the level of the fractured vertebrae but instead occurs in areas far away from the injured vertebrae, such as the lower back, area surrounding the iliac crest, or buttocks, and this type of pain is known as distant lumbosacral pain. The pathogenesis of pain in distant regions caused by thoracolumbar OVCF remains unclear.
To compare the clinical efficacy and imaging outcomes of percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in the treatment of distant lumbosacral pain accompanied by thoracolumbar OVCF and to explore the possible pathogenesis of distant lumbosacral pain caused by thoracolumbar OVCF.
Retrospective study.
A university hospital spinal surgery departments.
A total of 62 patients who underwent vertebral augmentation for thoracolumbar OVCF with lumbosacral pain were included and divided into the PVP group (28 cases) and the PKP group (34 cases). The Visual Analog Scale (VAS) was used to evaluate the severity of local and distant lumbosacral pain, and the Chinese modified Oswestry Disability Index (CMODI) was used for functional assessment. The anterior vertebral height (AVH) of the fractured vertebrae and local kyphotic angle were measured on plain radiographs. The average follow-up time was 28.62 ± 8.43 months in the PVP group and 29.22 ± 9.09 months in the PKP group.
Within the 2 groups, the VAS score of local pain, VAS score of distant lumbosacral pain, and CMODI score at 3 days postoperatively and at the last follow-up improved significantly compared with the scores before surgery. However, there was no significant difference between the 2 groups. At 3 days postoperatively and at last follow-up, the AVH and Cobb angle in the 2 groups improved significantly compared with those before surgery, but the magnitudes of AVH improvement and Cobb angle correction were significantly larger in the PKP group than in the PVP group.
First, this study is retrospective and may be prone to selection bias. Second, because of cultural and linguistic differences, the original version of the Oswestry Disability Index could not be properly understood and completed by people in mainland China. Therefore in this study, the CMODI was used, but the correlation coefficients of the CMODI within and between groups were 0.953 and 0.912, respectively. Third, a pain diagram was not used to accurately reflect the location of pain in the distant lumbosacral region.
Both PVP and PKP can effectively alleviate pain in the distant lumbosacral region caused by thoracolumbar OVCF, and distant lumbosacral pain associated with thoracolumbar OVCF may be considered vertebrogenic referred pain.
在临床实践中，我们发现胸腰椎骨质疏松性压缩性骨折（OVCF）引起的疼痛不仅局限于骨折椎体水平，还会出现在远离受伤椎体的部位，如腰部、髂嵴周围或臀部，这种疼痛称为远位腰骶痛。胸腰椎 OVCF 引起的远位疼痛的发病机制尚不清楚。
比较经皮椎体成形术（PVP）和经皮椎体后凸成形术（PKP）治疗伴有远位腰骶痛的胸腰椎 OVCF 的临床疗效和影像学结果，并探讨胸腰椎 OVCF 引起远位腰骶痛的可能发病机制。
回顾性研究。
一所大学医院脊柱外科。
共纳入 62 例因胸腰椎 OVCF 伴腰骶痛行椎体增强术的患者，分为 PVP 组（28 例）和 PKP 组（34 例）。采用视觉模拟评分（VAS）评估局部和远位腰骶痛的严重程度，采用中国改良 Oswestry 功能障碍指数（CMODI）进行功能评估。测量骨折椎体的前椎体高度（AVH）和局部后凸角。PVP 组平均随访时间为 28.62±8.43 个月，PKP 组为 29.22±9.09 个月。
两组患者术后 3 天及末次随访时的局部疼痛 VAS 评分、远位腰骶痛 VAS 评分及 CMODI 评分均较术前明显改善，但两组间无统计学差异。两组患者术后 3 天及末次随访时的 AVH 和 Cobb 角均较术前明显改善，但 PKP 组的 AVH 改善程度和 Cobb 角矫正程度明显大于 PVP 组。
首先，本研究为回顾性研究，可能存在选择偏倚。其次，由于文化和语言差异，中文版 Oswestry 功能障碍指数不能被中国大陆的人正确理解和完成。因此，在本研究中，采用了 CMODI，但 CMODI 组内和组间的相关系数分别为 0.953 和 0.912。第三，未使用疼痛图准确反映远位腰骶区疼痛的位置。
PVP 和 PKP 均可有效缓解胸腰椎 OVCF 引起的远位腰骶部疼痛，胸腰椎 OVCF 伴远位腰骶痛可能为椎源性牵涉痛。
