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Review
. 2025 Aug;17(8):2266-2280.
doi: 10.1111/os.70095. Epub 2025 Jun 26.

The Prevalence and Risk Factors of Residual Back Pain After Vertebroplasty for Osteoporotic Vertebral Compression Fractures: A Systematic Review and Meta-Analysis

Wenlong Li  1 , Bing Zhang  1 , Chencheng Mei  2 , Hui Li  1 , Ruizheng Zhu  3 , Hao Lin  1 , Jianmin Wen  4 , Yang Wu  1 , Xianzhi Ma  1
Affiliations
Review

The Prevalence and Risk Factors of Residual Back Pain After Vertebroplasty for Osteoporotic Vertebral Compression Fractures: A Systematic Review and Meta-Analysis

Wenlong Li et al. Orthop Surg. 2025 Aug.

Abstract

Background: Osteoporotic vertebral compression fractures (OVCFs) are prevalent among the elderly. Percutaneous vertebroplasty (PVA) is a commonly adopted minimally invasive treatment, yet many patients endure residual back pain (RBP) posttreatment, affecting their recovery and quality of life. Given the inconsistent prevalence of RBP across studies and the multitude of influencing factors, a systematic review and meta-analysis is necessary to determine its prevalence and identify risk factors.

Methods: English (PubMed, Embase, Web of Science, Ovid, Cochrane Library) and Chinese (CNKI, WanFang Data, VIP, CBM) literature databases were systematically searched until December 31, 2023. A random-effects meta-analysis was used to pool prevalence rates from individual studies. The associations between the identified risk factors and RBP were also analyzed. Sensitivity and subgroup analyzes were performed to identify the source of heterogeneity and to compare the prevalence estimates across the groups. The Joanna Briggs Institute's (JBIs) quality assessment checklist was used to evaluate the quality of the included studies. The I2 tests were used to assess heterogeneity among the studies.

Results: A total of 5146 articles were collected. Finally, 26 articles involving 9703 participants were included. Among them, 1245 experienced RBP. The prevalence of RBP in individual studies ranged from 4.56% to 50.00%, with a median of 14.90%. The pooled prevalence was 16.3% (95% CI: 13.5%-19.1%). The prevalence was higher among females [16.1% (95% CI: 13.1%-19.1%)] than males [15.9% (95% CI: 12.5%-19.2%)]. Subgroup analysis based on evaluation time showed that the prevalence was higher at 3 months or more after surgery [total: 17.3% (95% CI: 13.2%-21.4%) vs. 15.7% (95% CI: 12.1%-19.2%), males: 16.5% (95% CI: 12.3%-20.6%) vs. 15.3% (95% CI: 11.0%-19.6%), females: 16.9% (95% CI: 12.6%-21.1%) vs. 15.5% (95% CI: 11.6%-19.5%)]. Regarding the risk factors, several factors demonstrated significant associations with RBP. Patients with low pre-bone mineral density were more likely to experience RBP compared to those with higher density. Moreover, thoracolumbar fascia injury, unsatisfactory cement distribution, multiple vertebral fractures, and postoperative vertebral body height recovery rate were also identified as risk factors increasing the likelihood of RBP.

Conclusion: RBP is common after PVA, indicating the imperative of intervention strategies to alleviate the suffering and reduce negative ramifications. Moreover, various risk factors should be comprehensively considered to accurately assess patients' conditions and formulate targeted treatment and rehabilitation plans to alleviate patients' RBP symptoms.

Keywords: meta‐analysis; osteoporotic vertebral compression fractures; percutaneous vertebroplasty; residual back pain; systematic review.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
The article selection process.
FIGURE 2
FIGURE 2
Quality of included studies.
FIGURE 3
FIGURE 3
Quality of included studies summary (green represents yes, red represents no, yellow represents unclear).
FIGURE 4
FIGURE 4
The prevalence of RBP after PVA.
FIGURE 5
FIGURE 5
The prevalence of RBP after PVA in males.
FIGURE 6
FIGURE 6
The prevalence of RBP after PVA in females.
FIGURE 7
FIGURE 7
Sensitivity analysis.
FIGURE 8
FIGURE 8
The risk factors of RBP after PVA.
See this image and copyright information in PMC

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