Feng Tao, Jin Shengyang, Niu Junjie, Yan Qi, Song Dawei, Wang Jinning
Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, People's Republic of China.
Patient Relat Outcome Meas. 2025 Aug 16;16:117-127. doi: 10.2147/PROM.S529923. eCollection 2025.
Residual low back pain (LBP) is frequently reported after percutaneous kyphoplasty (PKP) for osteoporotic vertebral fractures (OVFs), yet its underlying mechanisms remain unclear. Paravertebral muscles (PVMs) degeneration, particularly fat infiltration and atrophy may contribute to persistent postoperative pain.
To evaluate the association between PVMs degeneration and residual LBP after PKP and identify imaging-based predictors for risk stratification.
This retrospective cohort study included 213 patients (mean age 70.88 ± 8.58 years; 82.2% female) with single-level OVFs who underwent PKP between January 2021 and June 2023. Patients with multiple-level fractures, chronic LBP, neurological deficits, prior spinal surgery, incomplete imaging, or inadequate follow-up were excluded. Fat infiltration percentage (FI%) and cross-sectional area of the multifidus (MF), erector spinae (ES), and psoas major (PS) were measured at the L4 level using transverse T2-weighted MRI. Residual LBP was defined as postoperative VAS ≥3.5 at 12-month follow-up. Logistic regression and ROC analyses were conducted and appropriate univariate tests (-test or Mann-Whitney -test) were performed.
Residual LBP occurred in 13.6% of patients and was associated with higher VBQ scores (3.14 ± 0.38 vs 2.57 ± 0.25, P=0.001), greater postoperative kyphosis (16.03 ± 6.69° vs 6.70 ± 4.80°, =0.001), increased FI% of ES/MF (57.28 ± 5.63% vs 43.40 ± 14.93%, =0.001), reduced PS area (10.74 ± 4.23 cm² vs 16.15 ± 3.71 cm², =0.001), and concentrated cement distribution (11.5% vs 73.6%, P=0.001). Independent predictors included elevated VBQ (OR=85.2, 95% CI 7.006-1036.458), kyphosis (OR=1.14, 95% CI 1.017-1.276), FI% of ES/MF (OR=1.082, 95% CI 1.008-1.160), and PS area (OR=0.509, 95% CI 0.285-0.910). ROC analysis identified FI% ≥49.78% and PS area ≤11.937 cm² as optimal cutoffs.
Preoperative magnetic resonance imaging assessment of paravertebral muscle may help identify patients at risk for residual low back pain after kyphoplasty. Incorporating preoperative imaging and postoperative physical therapy referral may improve patient outcomes.
经皮椎体后凸成形术（PKP）治疗骨质疏松性椎体骨折（OVF）后，残留下腰痛（LBP）的情况屡见不鲜，但其潜在机制尚不清楚。椎旁肌（PVM）退变，尤其是脂肪浸润和萎缩可能导致术后持续疼痛。
评估PKP术后PVM退变与残留LBP之间的关联，并确定基于影像学的风险分层预测指标。
这项回顾性队列研究纳入了2021年1月至2023年6月期间接受PKP治疗的213例单节段OVF患者（平均年龄70.88±8.58岁；82.2%为女性）。排除多节段骨折、慢性LBP、神经功能缺损、既往脊柱手术史、影像学不完整或随访不充分的患者。使用横轴位T2加权MRI在L4水平测量多裂肌（MF）、竖脊肌（ES）和腰大肌（PS）的脂肪浸润百分比（FI%）和横截面积。残留LBP定义为随访12个月时术后视觉模拟评分（VAS）≥3.5。进行逻辑回归和ROC分析，并进行适当的单变量检验（t检验或Mann-Whitney U检验）。
13.6%的患者出现残留LBP，且与较高的椎体骨折质量评分（VBQ）（3.14±0.38对2.57±0.25，P=0.001）（此处原文可能有误，推测为椎体骨折质量评分，原英文vertebral body quality score首字母大写不合理，推测为vertebral body quantity score，翻译为椎体骨折质量评分）、更大的术后后凸畸形（16.03±6.69°对6.70±4.80°，P=0.001）、ES/MF的FI%增加（57.28±5.63%对43.40±14.93%，P=0.001）、PS面积减小（10.74±4.23cm²对16.15±3.71cm²，P=0.001）以及骨水泥分布集中（11.5%对73.6%，P=0.001）相关。独立预测指标包括升高的VBQ（OR=85.2，95%CI 7.006 - 1036.458）、后凸畸形（OR=1.14，95%CI 1.017 - 1.276）、ES/MF的FI%（OR=1.082，95%CI 1.008 - 1.160）和PS面积（OR=0.509，95%CI 0.285 - 0.910）。ROC分析确定FI%≥49.78%和PS面积≤11.937cm²为最佳截断值。
术前对椎旁肌进行磁共振成像评估可能有助于识别椎体后凸成形术后残留下腰痛风险的患者。结合术前影像学检查和术后物理治疗转诊可能改善患者预后。
