Osteoporotic vertebral compression fracture accompanied with thoracolumbar fascial injury: risk factors and the association with residual pain after percutaneous vertebroplasty

Abstract

Background: To explore the risk factors involved in the induction of thoracolumbar fascia (TLF) injury by osteoporotic vertebral compression fracture (OVCF), and the association between the residual pain after percutaneous vertebroplasty (PVP) and fascial injury.

Methods: A total of 81 patients with single-segment OVCF, treated between January 2018 and January 2020 were included. The patients were grouped according to the existence of TLF injury. The patients' general, clinical, and imaging data were accessed.

Results: There were 47 patients in the TLF group and 34 in the non-injury group (NTLF group). In the TLF group, BMI (Body mass index) was significantly lower, while the prevalence of hypertension and sarcopenia were significantly higher (P < 0.05). The vertebral compression degree was higher, and the kyphosis angle of the injured vertebra was greater in the TLF group (P < 0.05). Cobb's angle was not significantly different between groups. At 3-d after the operation, the VAS (Visual analogue scale) was 4.64 ± 1.78 and 3.00 ± 1.71, and the ODI (Oswestry disability index) was 67.44 ± 11.37% and 56.73 ± 10.59% in TLF and NTLF group, respectively (P < 0.05). However, at 3-m after the operation, the differences in the VAS score and the ODI between groups were not statistically significant. The area of fascial edema was not significantly associated with the pre- and post-operative VAS or ODI, but was positively correlated with the vertebral body compression degree (R = 0.582, P = 0. 029).

Conclusion: Residual back pain after PVP is associated with TLF injury. Low BMI, hypertension and sarcopenia are risk factors of TLF injury, and sarcopenia may be the major factor.

Keywords: Osteoporotic vertebral compression fracture; PVP residual pain; Thoracolumbar fascia; compression fracture; percutaneous vertebroplasty.

Fig. 1

Vertebral compression fractures in the L1 vertebrae with TLF injury. A the T1WI image shows low signal intensity; B and C. T2WI image show high signal intensity; D. T2WI STIR sequence show high signal intensity; E. the site with the largest thoracolumbar fascial edema was selected

Fig. 2

The TPA at level L3 was measured on CT by tracing the bilateral psoas major muscle outline

Fig. 3

Preoperative X-ray imaging. A kyphosis angle; B Cobb’s angle; C vertebral compression degree (cd-ab/cd)

Fig. 4

Flowchart describing the inclusion of patients