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Back pain from painful osteoporotic vertebral fractures: discrepancy between the actual fracture location and the location suggested by patient-reported pain or physical examination findings

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Abstract

Summary

Caution is necessary when using symptom or physical examination findings to localize the osteoporotic vertebral fractures (VFs) attributable to the discrepant colocalized relationship.

Introduction

Whether the location of symptoms or physical examination findings delineates the appropriate spinal range for imaging has not been thoroughly investigated for VFs. The present study aims to analyze the consistency between the fractural vertebrae location and the location suggested by patient-reported pain or physical examination findings.

Methods

This observational study, following a prospective design, enrolled 358 patients with VFs. The locations of two symptoms (patient-reported back pain [P-RBP], radiating pain [RP]) and findings from two physical examinations (spinal palpation tenderness [SPT], axial spinal percussion pain [ASPP]) were used to locate the VF segments identified using whole-spine magnetic resonance imaging (MRI). The percentage of agreements and kappa coefficient were calculated.

Results

In 20.7% (74/358), the P-RBP site and VF segments were in the same location (kappa = 0.153); 21.2% (76/358) presented with concomitant RP in 93.4% (71/76) of whom the RP dermatome was colocalized with the VF segments (kappa = 0.924); 55.0% (197/358) and 23.2% (83/358) of patients presented with positive SPT and ASPP, respectively; and in 49.2% (97/197) and 96.4% (80/83) of patients with positive SPT (kappa = 0.435) and ASPP (kappa = 0.963), the positive finding and the VF segments were consistently colocalized.

Conclusions

The positive finding of RP or ASPP is useful in determining the spinal range for imaging tests, while an MRI scan covering the whole thoracic and lumbar spine is necessary in VF-suspected patients with P-RBP or positive SPT, indicating that caution is necessary when using symptoms or physical examination findings to localize VFs.

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Acknowledgments

We thank Dr. Hui Lin (Department of Gastroenterology, Xinqiao Hospital, Army Medical University, Chongqing, China) for reviewing the statistical analysis and interpretation of the results. We thank Dr. Chunyan Lu (Department of Endocrinology, Huaxi Hospital, Sichuan University, Chengdu, China) for the help in drafting the manuscript. We would like to thank all the professors and staffs (Department of Radiology, Daping Hospital, Chongqing, China) for their tremendous efforts in performing imaging examinations. Last but not the least, we acknowledge the study participants for their cooperation throughout the whole study procedure.

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Authors and Affiliations

  1. Department of Spine Surgery, Center of Orthopedics, Daping Hospital (Army Medical Center of PLA), Army Medical University, No. 10 Changjiang Branch Road, Yuzhong District, Chongqing, China

    H. Jin, Y. Liu, M. Liu, X. Yin, W. Fan, J. Zhu, J.H. Zhao & P. Liu

  2. Department of Orthopedics and Neurosurgery, Army 954th Hospital, Shannan, Tibet, China

    H. Jin

  3. Department of Wound Infection and Drug, State Key Laboratory of Trauma, Burns and Combined Injury, Research Institute of Surgery, Daping Hospital (Army Medical Center of PLA), Army Medical University, Chongqing, China

    X. Ma

  4. Laboratory for the Rehabilitation of Traumatic Injuries, Center of Bone Metabolism and Repair, State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Research Institute of Surgery, Daping Hospital (Army Medical Center of PLA), Army Medical University, Chongqing, China

    L. Chen, N. Su, Y. Xie & J. Yang

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  1. H. Jin
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  10. N. Su
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  13. P. Liu
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Corresponding author

Correspondence to P. Liu.

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Written informed consent was obtained from each participant. The Human Ethics Committee of the Third Affiliated Hospital of Army Medical University approved the study procedures and consent form (approval number 2016-16).

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Huaijian Jin and Xiaoyuan Ma are the first author

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Jin, H., Ma, X., Liu, Y. et al. Back pain from painful osteoporotic vertebral fractures: discrepancy between the actual fracture location and the location suggested by patient-reported pain or physical examination findings. Osteoporos Int 31, 1721–1732 (2020). https://doi.org/10.1007/s00198-020-05434-9

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  • DOI: https://doi.org/10.1007/s00198-020-05434-9

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