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Is thoracolumbar fascia injury the cause of residual back pain after percutaneous vertebroplasty? A prospective cohort study

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Abstract

Summary

Some patients with osteoporotic vertebral compression fractures still suffer from back pain after percutaneous vertebroplasty. We have found that osteoporotic vertebral compression fractures with thoracolumbar fascia injury are common and that thoracolumbar fascia injury may account for the residual pain after percutaneous vertebroplasty.

Purpose

Osteoporotic vertebral compression fractures are successfully treated with percutaneous vertebroplasty (PVP). However, some patients still suffer from back pain after the procedure. We hypothesized that there is a relationship between thoracolumbar (TL) fascia injury and residual postoperative pain.

Methods

This prospective study included 133 elderly patients (age range 55 – 92 years) with osteoporotic vertebral compression fractures treated with PVP from February 2010 to March 2012 in our hospital. The patients were divided into two groups based on the presence of TL fascia injury. A visual analog scale (VAS) and the Chinese modified Oswestry Disability Index were used to evaluate the pain before and after PVP.

Results

The mean VAS score and the Chinese modified Oswestry Disability Index in the patients with TL fascia injury were reduced from 9.11 ± 0.76 to 6.4 ± 1.1 and 73.93 ± 1.46 % to 44.6 ± 3.1 %, respectively, and in the patients without TL fascia injury from 9.26 ± 0.82 to 8.0 ± 1.3 and 73.96 ± 1.38 % to 51.7 ± 1.8 %, respectively. Pain and disability were reduced more in patients without TL fascia injury than in those with TL fascia injury (both p < 0.05).

Conclusions

There may be a relationship between TL fascia injury and residual back pain after PVP.

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References

  1. Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726–1733

    Article  CAS  PubMed  Google Scholar 

  2. Buchbinder R, Osborne RH, Ebeling PR, Wark JD, Mitchell P, Wriedt C, Graves S, Staples MP, Murphy B (2009) A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med 361:557–568

    Article  CAS  PubMed  Google Scholar 

  3. Kallmes DF, Comstock BA, Heagerty PJ, Turner JA, Wilson DJ, Diamond TH, Edwards R, Gray LA, Stout L, Owen S, Hollingworth W, Ghdoke B, Annesley-Williams DJ, Ralston SH, Jarvik JG (2009) A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med 361:569–579

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  4. Alvarez L, Alcaraz M, Perez-Higueras A, Granizo JJ, de Miguel I, Rossi RE, Quinones D (2006) Percutaneous vertebroplasty: functional improvement in patients with osteoporotic compression fractures. Spine (Phila Pa 1976) 31:1113–1118

    Article  Google Scholar 

  5. Diamond TH, Bryant C, Browne L, Clark WA (2006) Clinical outcomes after acute osteoporotic vertebral fractures: a 2-year non-randomised trial comparing percutaneous vertebroplasty with conservative therapy. Med J Aust 184:113–117

    PubMed  Google Scholar 

  6. Grafe IA, Baier M, Noldge G, Weiss C, Da FK, Hillmeier J, Libicher M, Rudofsky G, Metzner C, Nawroth P, Meeder PJ, Kasperk C (2008) Calcium-phosphate and polymethylmethacrylate cement in long-term outcome after kyphoplasty of painful osteoporotic vertebral fractures. Spine (Phila Pa 1976) 33:1284–1290

    Article  Google Scholar 

  7. Grafe IA, Da FK, Hillmeier J, Meeder PJ, Libicher M, Noldge G, Bardenheuer H, Pyerin W, Basler L, Weiss C, Taylor RS, Nawroth P, Kasperk C (2005) Reduction of pain and fracture incidence after kyphoplasty: 1-year outcomes of a prospective controlled trial of patients with primary osteoporosis. Osteoporos Int 16:2005–2012

    Article  PubMed  Google Scholar 

  8. Kasperk C, Grafe IA, Schmitt S, Noldge G, Weiss C, Da FK, Hillmeier J, Libicher M, Sommer U, Rudofsky G, Meeder PJ, Nawroth P (2010) Three-year outcomes after kyphoplasty in patients with osteoporosis with painful vertebral fractures. J Vasc Interv Radiol 21:701–709

    Article  PubMed  Google Scholar 

  9. Kasperk C, Hillmeier J, Noldge G, Grafe IA, Dafonseca K, Raupp D, Bardenheuer H, Libicher M, Liegibel UM, Sommer U, Hilscher U, Pyerin W, Vetter M, Meinzer HP, Meeder PJ, Taylor RS, Nawroth P (2005) Treatment of painful vertebral fractures by kyphoplasty in patients with primary osteoporosis: a prospective nonrandomized controlled study. J Bone Miner Res 20:604–612

    Article  PubMed  Google Scholar 

  10. Klazen CA, Lohle PN, de Vries J, Jansen FH, Tielbeek AV, Blonk MC, Venmans A, van Rooij WJ, Schoemaker MC, Juttmann JR, Lo TH, Verhaar HJ, van der Graaf Y, van Everdingen KJ, Muller AF, Elgersma OE, Halkema DR, Fransen H, Janssens X, Buskens E, Mali WP (2010) Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial. Lancet 376:1085–1092

    Article  PubMed  Google Scholar 

  11. Komp M, Ruetten S, Godolias G (2004) Minimally invasive therapy for functionally unstable osteoporotic vertebral fracture by means of kyphoplasty: prospective comparative study of 19 surgically and 17 conservatively treated patients. J Miner Stoffwechs 11(Suppl 1):13–15

    Google Scholar 

  12. Voormolen MH, Mali WP, Lohle PN, Fransen H, Lampmann LE, van der Graaf Y, Juttmann JR, Jansssens X, Verhaar HJ (2007) Percutaneous vertebroplasty compared with optimal pain medication treatment: short-term clinical outcome of patients with subacute or chronic painful osteoporotic vertebral compression fractures. The VERTOS study. AJNR Am J Neuroradiol 28:555–560

    CAS  PubMed  Google Scholar 

  13. Wardlaw D, Cummings SR, Van Meirhaeghe J, Bastian L, Tillman JB, Ranstam J, Eastell R, Shabe P, Talmadge K, Boonen S (2009) Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture: a randomised controlled trial. Lancet 373:1016–1024

    Article  PubMed  Google Scholar 

  14. Eidt-Koch D, Greiner W (2011) Quality of life results of balloon kyphoplasty versus non surgical management for osteoporotic vertebral fractures in Germany. Health Econ Rev 1:7

    Article  PubMed Central  PubMed  Google Scholar 

  15. Bornemann R, Hanna M, Kabir K, Goost H, Wirtz DC, Pflugmacher R (2012) Continuing conservative care versus crossover to radiofrequency kyphoplasty: a comparative effectiveness study on the treatment of vertebral body fractures. Eur Spine J 21:930–936

    Article  PubMed Central  PubMed  Google Scholar 

  16. Movrin I (2012) Adjacent level fracture after osteoporotic vertebral compression fracture: a nonrandomized prospective study comparing balloon kyphoplasty with conservative therapy. Wien Klin Wochenschr 124:304–311

    Article  PubMed  Google Scholar 

  17. Wardlaw D, Van Meirhaeghe J, Ranstam J, Bastian L, Boonen S (2012) Balloon kyphoplasty in patients with osteoporotic vertebral compression fractures. Expert Rev Med Devices 9:423–436

    Article  CAS  PubMed  Google Scholar 

  18. Boonen S, Van Meirhaeghe J, Bastian L, Cummings SR, Ranstam J, Tillman JB, Eastell R, Talmadge K, Wardlaw D (2011) Balloon kyphoplasty for the treatment of acute vertebral compression fractures: 2-year results from a randomized trial. J Bone Miner Res 26:1627–1637

    Article  PubMed  Google Scholar 

  19. Lakadamyali H, Tarhan NC, Ergun T, Cakir B, Agildere AM (2008) STIR sequence for depiction of degenerative changes in posterior stabilizing elements in patients with lower back pain. AJR Am J Roentgenol 191:973–979

    Article  PubMed  Google Scholar 

  20. Kjaer P, Bendix T, Sorensen JS, Korsholm L, Leboeuf-Yde C (2007) Are MRI-defined fat infiltrations in the multifidus muscles associated with low back pain? BMC Med 5:2

    Article  PubMed Central  PubMed  Google Scholar 

  21. Lyritis GP, Mayasis B, Tsakalakos N, Lambropoulos A, Gazi S, Karachalios T, Tsekoura M, Yiatzides A (1989) The natural history of the osteoporotic vertebral fracture. Clin Rheumatol 8(Suppl 2):66–69

    Article  PubMed  Google Scholar 

  22. Takeda N, Kobayashi T, Atsuta Y, Matsuno T, Shirado O, Minami A (2009) Changes in the sagittal spinal alignment of the elderly without vertebral fractures: a minimum 10-year longitudinal study. J Orthop Sci 14:748–753

    Article  PubMed  Google Scholar 

  23. Lyles KW, Gold DT, Shipp KM, Pieper CF, Martinez S, Mulhausen PL (1993) Association of osteoporotic vertebral compression fractures with impaired functional status. Am J Med 94:595–601

    Article  CAS  PubMed  Google Scholar 

  24. Schlaich C, Minne HW, Bruckner T, Wagner G, Gebest HJ, Grunze M, Ziegler R, Leidig-Bruckner G (1998) Reduced pulmonary function in patients with spinal osteoporotic fractures. Osteoporos Int 8:261–267

    Article  CAS  PubMed  Google Scholar 

  25. Leech JA, Dulberg C, Kellie S, Pattee L, Gay J (1990) Relationship of lung function to severity of osteoporosis in women. Am Rev Respir Dis 141:68–71

    Article  CAS  PubMed  Google Scholar 

  26. Silverman SL (1992) The clinical consequences of vertebral compression fracture. Bone 13(Suppl 2):S27–S31

    Article  PubMed  Google Scholar 

  27. Afzal S, Dhar S, Vasavada NB, Akbar S (2007) Percutaneous vertebroplasty for osteoporotic fractures. Pain Physician 10:559–563

    PubMed  Google Scholar 

  28. Cortet B, Cotten A, Boutry N, Flipo RM, Duquesnoy B, Chastanet P, Delcambre B (1999) Percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures: an open prospective study. J Rheumatol 26:2222–2228

    CAS  PubMed  Google Scholar 

  29. Deramond H, Depriester C, Galibert P, Le Gars D (1998) Percutaneous vertebroplasty with polymethylmethacrylate. Technique, indications, and results. Radiol Clin N Am 36:533–546

    Article  CAS  PubMed  Google Scholar 

  30. Predey TA, Sewall LE, Smith SJ (2002) Percutaneous vertebroplasty: new treatment for vertebral compression fractures. Am Fam Physician 66:611–615

    PubMed  Google Scholar 

  31. Peters KR, Guiot BH, Martin PA, Fessler RG (2002) Vertebroplasty for osteoporotic compression fractures: current practice and evolving techniques. Neurosurgery 51:S96–S103

    Article  PubMed  Google Scholar 

  32. Han S, Wan S, Ning L, Tong Y, Zhang J, Fan S (2011) Percutaneous vertebroplasty versus balloon kyphoplasty for treatment of osteoporotic vertebral compression fracture: a meta-analysis of randomised and non-randomised controlled trials. Int Orthop 35:1349–1358

    Article  PubMed Central  PubMed  Google Scholar 

  33. Hirsch JA, Do HM, Kallmes D, Ruedy RM, Jarvik JG (2003) Simplicity of randomized, controlled trials of percutaneous vertebroplasty. Pain Physician 6:342–343

    PubMed  Google Scholar 

  34. Eom KS, Kim TY (2012) Percutaneous vertebroplasty-induced adjacent vertebral compression fracture. Pain Physician 15:E527–E532

    PubMed  Google Scholar 

  35. Rousing R, Andersen MO, Jespersen SM, Thomsen K, Lauritsen J (2009) Percutaneous vertebroplasty compared to conservative treatment in patients with painful acute or subacute osteoporotic vertebral fractures: three-months follow-up in a clinical randomized study. Spine (Phila Pa 1976) 34:1349–1354

    Article  Google Scholar 

  36. Rousing R, Hansen KL, Andersen MO, Jespersen SM, Thomsen K, Lauritsen JM (2010) Twelve-months follow-up in forty-nine patients with acute/semiacute osteoporotic vertebral fractures treated conservatively or with percutaneous vertebroplasty: a clinical randomized study. Spine (Phila Pa 1976) 34:478–482

    Article  Google Scholar 

  37. Liu JT, Liao WJ, Tan WC, Lee JK, Liu CH, Chen YH, Lin TB (2010) Balloon kyphoplasty versus vertebroplasty for treatment of osteoporotic vertebral compression fracture: a prospective, comparative, and randomized clinical study. Osteoporos Int 21:359–364

    Article  CAS  PubMed  Google Scholar 

  38. Barr JD, Barr MS, Lemley TJ, McCann RM (2000) Percutaneous vertebroplasty for pain relief and spinal stabilization. Spine 25:923–928

    Article  CAS  PubMed  Google Scholar 

  39. Diamond TH, Champion B, Clark WA (2003) Management of acute osteoporotic vertebral fractures: a nonrandomized trial comparing percutaneous vertebroplasty with conservative therapy. Am J Med 114:257–265

    Article  PubMed  Google Scholar 

  40. Layton KF, Thielen KR, Koch CA, Luetmer PH, Lane JI, Wald JT, Kallmes DF (2007) Vertebroplasty, first 1000 levels of a single center: evaluation of the outcomes and complications. AJNR Am J Neuroradiol 28:683–689

    CAS  PubMed  Google Scholar 

  41. Kobayashi K, Shimoyama K, Nakamura K, Murata K (2005) Percutaneous vertebroplasty immediately relieves pain of osteoporotic vertebral compression fractures and prevents prolonged immobilization of patients. Eur Radiol 15:360–367

    Article  PubMed  Google Scholar 

  42. Lin CC, Shen WC, Lo YC, Liu YJ, Yu TC, Chen IH, Chung HW (2010) Recurrent pain after percutaneous vertebroplasty. AJR Am J Roentgenol 194:1323–1329

    Article  PubMed  Google Scholar 

  43. Liu H, Tao H, Luo Z (2009) Validation of the simplified Chinese version of the Oswestry Disability Index. Spine (Phila Pa 1976) 34:1211–1216, 1217

    Article  Google Scholar 

  44. Guangxin Z, **aoou Z, Guanglin L, Lifeng Z (2002) Reliability of the modified oswestry disability index for evaluating patients with low back pain. Chin J Spine Spinal Cord 12:13–15

    Google Scholar 

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Acknowledgments

The authors thank Dr. Andreas Kiel of the Hospital Dresden-Friedrichstadt for proofreading the manuscript during preparation.

Conflicts of interest

There was no external funding for this study.

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Correspondence to R. Xu.

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Yan, Y., Xu, R. & Zou, T. Is thoracolumbar fascia injury the cause of residual back pain after percutaneous vertebroplasty? A prospective cohort study. Osteoporos Int 26, 1119–1124 (2015). https://doi.org/10.1007/s00198-014-2972-2

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