Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Youyidong Road 555, Xi'an City, Shaanxi Province, China.
Yan'an University, Yan'an City, Shaanxi Province, China.
Int Orthop. 2023 Jul;47(7):1797-1804. doi: 10.1007/s00264-023-05809-7. Epub 2023 Apr 19.
Residual back pain (RBP) after percutaneous vertebral augmentation (PVA) still exists considerable, and it even affects daily life due to moderate or severe back pain. A variety of risk factors have been previously identified for developing residual back pain. However, there are conflicting reports regarding the association between sarcopenia and residual back pain. As such, the aim of this study was to investigate whether paraspinal muscle fatty degeneration is a predictor of residual back pain.
We retrospectively reviewed the medical records of patients with single-segment OVCF who underwent PVA from January 2016 to January 2022. Patients were divided into RBP group (86 patients) and control group (790 patients) according to whether the visual analog scale (VAS) score ≥ 4. The clinical and radiological data were analyzed. Paraspinal musculature fatty degeneration was measured using the Goutallier classification system (GCS) at the L4 - 5 intervertebral disc level. Univariate and multivariate logistic regression analyses were performed to identify risk factors.
The results of multivariate logistical regression analysis revealed that posterior fascia injury (odds ratio (OR) = 5.23; 95% confidence interval (CI) 3.12-5.50; P < 0.001), as regards paraspinal muscle fatty degeneration, including Goutallier grading (OR = 12.23; 95% CI 7.81-23.41; P < 0.001), fCSA (OR = 3.06; 95% CI 1.63-6.84; P = 0.002), fCSA/CSA (%) (OR = 14.38; 95% CI 8.80-26.29; P < 0.001), and facet joint violation (OR = 8.54; 95% CI 6.35-15.71; P < 0.001) were identified as independent risk factors for RBP.
Posterior fascia injury, paraspinal muscle fatty degeneration, and facet joint violation were identified as independent risk factors for RBP, with paraspinal muscle fatty degeneration playing an important role.
经皮椎体强化（PVA）后仍存在相当程度的残余背痛（RBP），且由于中重度背痛而影响日常生活。先前已经确定了多种发生残余背痛的风险因素。然而，关于肌肉减少症与残余背痛之间的关联，存在相互矛盾的报告。因此，本研究旨在探讨脊柱旁肌肉脂肪变性是否是残余背痛的预测指标。
我们回顾性分析了 2016 年 1 月至 2022 年 1 月接受 PVA 治疗的单节段 OVCF 患者的病历。根据视觉模拟量表（VAS）评分≥4 将患者分为 RBP 组（86 例）和对照组（790 例）。分析了临床和影像学资料。采用 Goutallier 分级系统（GCS）在 L4-5 椎间盘水平测量脊柱旁肌肉脂肪变性。采用单因素和多因素逻辑回归分析来确定风险因素。
多因素逻辑回归分析结果显示，后筋膜损伤（比值比（OR）=5.23；95%置信区间（CI）3.12-5.50；P<0.001），包括脊柱旁肌肉脂肪变性，如 Goutallier 分级（OR=12.23；95%CI 7.81-23.41；P<0.001）、fCSA（OR=3.06；95%CI 1.63-6.84；P=0.002）、fCSA/CSA（%）（OR=14.38；95%CI 8.80-26.29；P<0.001）和关节突关节侵犯（OR=8.54；95%CI 6.35-15.71；P<0.001）是 RBP 的独立危险因素。
后筋膜损伤、脊柱旁肌肉脂肪变性和关节突关节侵犯是 RBP 的独立危险因素，其中脊柱旁肌肉脂肪变性起着重要作用。
