Percutaneous Vertebroplasty Versus Kyphoplasty for Thoracolumbar Osteoporotic Vertebral Compression Fractures in Patients with Distant Lumbosacral Pain

Abstract

Background: 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. Objectives: 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. Study Design: Retrospective study. Setting: A university hospital spinal surgery departments. Methods: 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. Results: 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. Limitations: 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. Conclusions: 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. Key words: Osteoporotic vertebral compression fracture, distant pain, non-midline pain, kyphoplasty, vertebroplasty, vertebral augmentation, lumbosacral pain, Chinese modified Oswestry Disability Index

Percutaneous vertebroplasty for thoracolumbar osteoporotic vertebral compression fracture in patients with distant lumbosacral pain

“…There were few studies reported that percutaneous kyphoplasty could alleviate the DLP. [3][4][5][6] The results of this study showed signi cant improvements in the Cobb angle, anterior vertebral heights, VAS and CMODI after surgery. These outcomes can be attributed to the ability of PVP to restore vertebral height, eliminate micro-motion within the fractured vertebra, and alleviate the mechanical load exerted on the facet joints.…”

“…[3 , 6] It is commonly observed that lumbosacral pain in older patients is primarily attributed to degenerative changes in the lumbosacral region, [11][12][13] whereas the association between thoracolumbar OVCF and lumbosacral pain is less frequently documented. [6 , 14] Li et al [5] found that 33.9% of patients suffering from thoracolumbar OVCF experienced pain solely in the distant lumbosacral region, rather than in the immediate vicinity of the fractured vertebra. Given the prevalence of lumbar degenerative changes in the elderly population, these OVCF patients are susceptible to being misdiagnosed with lumbar degenerative diseases.…”

Efficacy and Complication Rates of Percutaneous Vertebroplasty and Kyphoplasty in the Treatment of Vertebral Compression Fractures: A Retrospective Analysis of 280 Patients

“…Early PVPs or PKPs without an initial trial of conservative therapy may be considered as overtreatment. On the contrary, delayed procedures may not be as effective, not only in reducing a potentially wedged vertebra, but also in dealing with residual pain [ 13 ]. We are inclined more towards early VPs because we consider fracture reduction to be sufficiently achievable only in acute fractures.…”

Treatment for Osteoporotic Vertebral Fracture - A Short Review of Orthosis and Percutaneous Vertebroplasty and Balloon Kyphoplasty

“…With regard to the relationship between timing of BKP and clinical outcomes, a latest systematic review and meta-analysis of 13 studies concluded that early BKP intervention was associated with similar or better outcomes in terms of pain relief, functional improvement, restoration of vertebral height, and correction of kyphosis deformity when compared to delayed BKP intervention [ 45 ]. A meta-analysis showed no significant difference in cement leak rates between early and late BKP (OR, 1.60; 95% CI, 0.97–2.64; p = 0.07), while delayed BKP was associated with a higher risk of adjacent vertebral fracture than early BKP (OR, 0.31; 95% CI, 0.…”