Graduate School of Ningxia Medical University, Yinchuan, Ningxia, China.
Department of Orthopedics, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, China.
Pain Res Manag. 2021 Nov 1;2021:3624614. doi: 10.1155/2021/3624614. eCollection 2021.
Current findings suggest that percutaneous vertebroplasty (PVP) is a suitable therapeutic approach for osteoporotic vertebral compression fractures (OVCFs). However, a significant minority of patients still experience residual back pain after PVP. The present retrospective study was designed to determine the risk factors for residual back pain after PVP and provides a nomogram for predicting the residual back pain after PVP.
We retrospectively reviewed the medical records of patients with single-segment OVCFs who underwent bilateral percutaneous vertebroplasty. Patients were divided into group N and group R according to the postoperative VAS score. Group R is described as the VAS score of residual back pain ≥ 4. Pre- and postoperative factors that may affect back pain relief were evaluated between two groups. Univariate and multivariate logistic regression analysis were performed to identify risk factors affecting residual back pain after PVP. We provided a nomogram for predicting the residual back pain and used the receiver operating characteristic curve (ROC), concordance index (C-index), calibration curve, and decision curve analyses (DCA) to evaluate the prognostic performance.
Among 268 patients treated with PVP, 37 (13.81%) patients were classified postoperative residual back pain. The results of the multivariate logistical regression analysis showed that the presence of an intravertebral vacuum cleft (IVC) (OR 3.790, =0.026), posterior fascia oedema (OR 3.965, =0.022), severe paraspinal muscle degeneration (OR 5.804, =0.01; OR 13.767, < 0.001), and blocky cement distribution (OR 2.225, =0.041) were independent risk factors for residual back pain after PVP. The AUC value was 0.780, suggesting that the predictive ability was excellent. The prediction nomogram presented good discrimination, with a C-index of 0.774 (0.696∼0.852) and was validated to be 0.752 through bootstrapping validation. The calibration curve of the nomogram demonstrated a good consistency between the probabilities predicted by the nomogram and the actual probabilities. The nomogram showed net benefits in the range from 0.06 to 0.66 in DCA.
The presence of IVC, posterior fascia oedema, blocky cement distribution, and severe paraspinal muscle degeneration were significant risk factors for residual back pain after PVP for OVCFs. Patients with OVCFs after PVP who have these risk factors should be carefully monitored for the possible development of residual back pain. We provide a nomogram for predicting the residual back pain after PVP.
目前的研究结果表明，经皮椎体成形术（PVP）是治疗骨质疏松性椎体压缩性骨折（OVCFs）的一种合适的治疗方法。然而，仍有相当一部分患者在 PVP 后仍存在残留腰痛。本回顾性研究旨在确定 PVP 后残留腰痛的危险因素，并提供预测 PVP 后残留腰痛的列线图。
我们回顾性分析了 268 例接受双侧经皮椎体成形术治疗的单节段 OVCFs 患者的病历。根据术后 VAS 评分将患者分为 N 组和 R 组。R 组描述为残留腰痛 VAS 评分≥4。评估两组间可能影响腰痛缓解的术前和术后因素。采用单因素和多因素逻辑回归分析确定影响 PVP 后残留腰痛的危险因素。我们提供了一个预测残留腰痛的列线图，并使用接受者操作特征曲线（ROC）、一致性指数（C-index）、校准曲线和决策曲线分析（DCA）来评估预后性能。
在接受 PVP 治疗的 268 例患者中，37 例（13.81%）患者被归类为术后残留腰痛。多因素逻辑回归分析结果显示，存在椎体内真空裂隙（IVC）（OR 3.790，=0.026）、后筋膜水肿（OR 3.965，=0.022）、严重的脊柱旁肌肉退变（OR 5.804，=0.01；OR 13.767，<0.001）和块状水泥分布（OR 2.225，=0.041）是 PVP 后残留腰痛的独立危险因素。AUC 值为 0.780，表明预测能力优秀。预测列线图具有良好的判别能力，C 指数为 0.774（0.696∼0.852），通过自举验证验证为 0.752。列线图的校准曲线表明，列线图预测的概率与实际概率之间具有良好的一致性。在 DCA 中，列线图在 0.06 到 0.66 的范围内显示出净收益。
存在 IVC、后筋膜水肿、块状水泥分布和严重的脊柱旁肌肉退变是 OVCFs 患者 PVP 后残留腰痛的显著危险因素。接受 PVP 治疗的 OVCFs 患者如果存在这些危险因素，应密切监测可能出现的残留腰痛。我们提供了一个预测 PVP 后残留腰痛的列线图。
