Hershkovich Oded, Sakhnini Mojahed, Lotan Raphael
Department of Orthopedic Surgery, Wolfson Medical Center, Holon 5822012, Israel.
Gray Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv-Yafo 6997801, Israel.
Geriatrics (Basel). 2025 May 24;10(3):71. doi: 10.3390/geriatrics10030071.
Vertebral Compression Fractures (VCF) are the most common vertebral fractures, usually osteoporotic, with rising incidence. The natural history of VCFs-related pain remains unclear, and treatment protocols are still being evaluated, ranging from conservative to surgical. Patient-reported measures have been proven inaccurate and carry significant biases. This study examines maximal tenderness location (MTL) to palpation and percussion on physical examination during VCF healing and the postoperative period.
A prospective study included 40 patients treated for VCFs per the NICE guidelines (2013) from 2019 to 2021. Treatment was either conservative ( = 12) or surgical ( - 28), Balloon Kyphoplasty (BKP). All patients' MTL were recorded in EMR (Electronic Medical Record) on every visit. BKP was offered for severe ongoing pain after a recent, unhealed vertebral fracture despite optimal pain management, progressive fracture collapse, or lack of union. Follow-up was six months. Pain evolution was analyzed using Kaplan-Meier survival curves, Log-Rank tests, Mann-Whitney U tests, -tests, and logistic regression models. A -value < 0.05 was considered statistically significant.
12 patients were treated conservatively, and 28 underwent BKP for T12-L2 VCFs, accounting for 75% of fractures, mostly single-level fractures. All initially suffered MTL over the VCF; BKP patients showed local VCF pain resolution after 3.5 weeks following surgery while lasting seven weeks under conservative treatment. Lumbosacral pain was more prevalent following BKP (OR = 4, = 0.05) and developed earlier.
This study is novel in relating physical examination findings to fracture age and treatment provided, suggesting that VCFs-related pain is a time-related shift from local fracture pain to lumbosacral pain. Patient-reported pain scales may not reliably distinguish between these varying pain patterns. These findings suggest that only local VCF pain should be considered for surgical treatment. Future studies evaluating VCF outcomes should address physical examination and not rely solely on patient-reported metrics.
椎体压缩性骨折（VCF）是最常见的椎体骨折，通常为骨质疏松性骨折，其发病率呈上升趋势。与VCF相关的疼痛的自然病史仍不清楚，治疗方案仍在评估中，范围从保守治疗到手术治疗。患者报告的测量方法已被证明不准确且存在重大偏差。本研究检查了VCF愈合期间及术后体格检查时触诊和叩诊的最大压痛部位（MTL）。
一项前瞻性研究纳入了2019年至2021年期间按照英国国家卫生与临床优化研究所（NICE）指南（2013年）接受VCF治疗的40例患者。治疗方法为保守治疗（n = 12）或手术治疗（n = 28），即球囊椎体后凸成形术（BKP）。每次就诊时，所有患者的MTL均记录在电子病历（EMR）中。对于尽管进行了最佳疼痛管理但近期未愈合的椎体骨折后仍有严重持续疼痛、骨折逐渐塌陷或未愈合的患者，提供BKP治疗。随访时间为6个月。使用Kaplan-Meier生存曲线、对数秩检验、Mann-Whitney U检验、t检验和逻辑回归模型分析疼痛演变情况。P值<0.05被认为具有统计学意义。
12例患者接受了保守治疗，28例因T12-L2椎体压缩性骨折接受了BKP治疗，占骨折病例的75%，大多为单节段骨折。所有患者最初的MTL均在VCF部位；BKP患者术后3.5周局部VCF疼痛缓解，而保守治疗持续7周。BKP后腰骶部疼痛更常见（OR = 4，P = 0.05）且出现更早。
本研究将体格检查结果与骨折年龄及所提供的治疗相关联，具有创新性，表明与VCF相关的疼痛是一个从局部骨折疼痛到腰骶部疼痛的时间相关转变。患者报告的疼痛量表可能无法可靠地区分这些不同的疼痛模式。这些发现表明，手术治疗仅应考虑局部VCF疼痛。未来评估VCF治疗效果的研究应关注体格检查，而不应仅依赖患者报告的指标。
