The Correlation Analysis And The Clinical Efficacy Of Percutaneous Vertebral Augmentation On Painful Osteoporotic Vertebral Compression Fractures With Different Symptoms Pattern

ObjectiveTo analyze the characteristics of different pain patterns resulting from osteoporotic vertebral compression fractures(OVCF), to compare the pre-and-post procedural clinical outcomes and to explore the different pain patterns to elucidate the pain mechanism and its related factors, to provide initial outcome of treatment with percutaneous vertebral augmentation (PVA).MethodsThe clinical data of103patients with single-level fresh osteoporotic vertebral osteonecrosis treated by PVA were analyzed retrospectively from November2012to December2013. Four pain patterns were formulized to classify pains dute to OVCFs:midline paravetebral (Group A, N=56%), axial back merge side rib pain(Group B,N=24%), stomachache pain distant to the fracture(Group C, N=7%),remote lumbosacral and illiac crest pain(Group D, N=13%). All cases received radiography, MRI and CT examination before operation. The clinical and imaging characteristics of these patients were analyzed. Acorrding to the lateral X-ray to judge spinal sagittal balance and the degree of the frac-ture. The height of the vertebral body represented as deformity index(DI), Cobb angles were measuresed in lateral radiographs at pre-operation, three days after operation, and at the final follow-up, respectively. Visual analog scale(VAS) and Oswestry disability index(ODI) were chosen to evaluate pain status and functional activity at the same time points. Statistcal analysis was performed using SPSS13.0software. the four groups were categorized as focal pain over the comprission fracture and pain distant to the frac-ture. Correlation of pain patterns was compared with multivarite logistic regression to describe the factors related to pain distant to the fra-cture. The pre-operation VAS and ODI existed among four groups was compared by analysis of variance(ANOVA). Differences in the deformity index, Cobb angle,VAS and ODI at pre-operation, three days after operation, and at the final follow-up were compared using paired t-test.ResultsAll patients were followed up6months on average. Asymptomatic bone cement leakage occurred in sixteen cases. Onset of new vertebral fracture occurred in nine cases. The Logistic regression analysis showed that bone mineral density, the degree of the fracture and the spinal sagittal balance is the main factor causing pain appeared in the distance. No significant difference in preprocedural VAS and ODI existed among four groups (P>0.05).The VAS and ODI which showed significant improvement between pre-operation and post-operation(P<0.05), while no difference between three days after operation and final follow-up in group D(P>0.05). There was statistically significant improvement in the VAS and ODI among the pre-operative, three days after operation and at the final follow-up assessments in the rest of the three groups (P<0.05). All patients showed significant improvemengt of Deformity Index, and significant diference existed among the four group(P<0.05). Four groups showed signfcant improvement of Cobb angle among the pre-operative, three days after operation and at the final follow-up assessments(P<0.05), except for group C showed no difference between three days after operation and the final follow-up (P>0.05).ConelusionOur retrospective study demonstrated that the Bone mineral density, the degree of the fracture and the spinal sagittal balance might influence the pain distant to the fracture. Percutaneous Vertebral Augmentation is effective for different pain patterns resulting from osteoporotic vertebral compression fractures.