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Risk Factors for Residual Back Pain After Balloon Kyphoplasty for Osteoporotic Vertebral Fracture

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Abstract

Background

Balloon kyphoplasty (BKP) is a method for the management of osteoporotic vertebral body fracture (OVF). However, improvement in back pain (BP) is poor in some patients, also previous reports have not elucidated the exact incidence and risk factors for residual BP after BKP. We clarified the characteristics of residual BP after BKP in patients with OVF.

Hypothesis

In this study, we hypothesize that some risk factors may exist for residual BP 2 years after the treatment of OVF with BKP.

Patients and Methods

A multicenter cohort study was performed where patients who received BKP within 2 months of OVF injury were followed-up for 2 years. BP at 6 months after surgery and final observation was evaluated by Visual Analog Scale (VAS) score. Patients with a score of 40 mm or more were allocated to the residual BP group, and comparisons between the residual back pain group and the improved group were made for bone density, kyphosis, mobility of the fractured vertebral body, total spinal column alignment, and fracture type (fracture of the posterior element, pedicle fracture, presence or absence of posterior wall damage, etc.). Also, Short Form 36 (SF-36) for physical component summary (PCS) and mental component summary (MCS) at the final follow-up was evaluated in each radiological finding.

Results

Of 116 cases, 79 (68%) were followed-up for 2 years. Two years after the BKP, 26 patients (33%) experienced residual BP. Neither age nor sex differed between the groups. In addition, there was no difference in bone mineral density, BKP intervention period (period from onset to BKP), and osteoporosis drug use. However, the preoperative height ratio of the vertebral body was significantly worse in the residual BP group (39.8% vs. 52.1%; p = 0.007). Two years after the operation, the vertebral body wedge angle was significantly greater in the residual BP group (15.7° vs. 11.9°; p = 0.042). In the multiple logistic regression model with a preoperative vertebral body height ratio of 50% or less [calculated by receiver operating characteristic (ROC) curve], the adjusted odds ratio for residual BP was 6.58 (95% confidence interval 1.64–26.30; p = 0.007); similarly, patients with vertebral body height ratio less than 50% had a lower score of SF-36 PCS 24.6 vs. 32.2 p = 0.08.

Conclusion

The incidence of residual BP 2 years after BKP was 33% in the current study. The risk factor for residual BP after BKP was a preoperative vertebral body height ratio of 50% or less, which should be attentively assessed for the selection of a proper treatment scheme and to provide adequate stabilization.

Level of Evidence

III.

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Data Availability

The data are available, upon reasonable request, from the corresponding author.

Code Availability

Not applicable.

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Acknowledgements

We thank Osaka metropolitan university’s orthopedic department and affiliated hospitals operation room staff for their contribution to the current study.

Funding

The Japan Agency for Medical Research and Development grant funds were received in support of this work.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, Japan

    Hamidullah Salimi, Shinji Takahashi, Masatoshi Hoshino, Yusuke Hori, Hidetomi Terai, Hiromitsu Toyoda, Akinobu Suzuki, Koji Tamai & Hiroaki Nakamura

  2. Department of Orthopaedic Surgery, Osaka General Hospital of West Japan Railway Company, Osaka, Japan

    Hiroyuki Yasuda

  3. Department of Orthopaedic Surgery, Shiraniwa Hospital, Nara, Japan

    Tadao Tsujio

  4. Department of Orthopaedic Surgery, Nishinomiya Watanabe Hospital, Nishinomiya, Hyogo, Japan

    Shoichiro Ohyama

  5. Department of Orthopaedic Surgery, Ishikiri Seiki Hospital, Osaka, Japan

    Hiroshi Kono

  6. Department of Orthopaedic Surgery, Yodogawa Christian Hospital, Osaka, Japan

    Sho Dohzono

Authors
  1. Hamidullah Salimi
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  2. Shinji Takahashi
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  13. Koji Tamai
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  14. Hiroaki Nakamura
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Contributions

ST, MH, and HN contributed to the study concept. YH, HY, TT, SO, HT, and AS contributed to data acquisition and analyses. ST and HS wrote the manuscript. HK, SD, KT, and HS contributed to data interpretation. All authors have read and approved the final version of the manuscript.

Corresponding author

Correspondence to Shinji Takahashi.

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Conflict of Interest

The authors declare that they have no competing interests.

Consent to Participate

Written informed consent was taken from the patients for the data and/or imaging documents to be presented in this article.

Ethical Standard

The study protocol was approved by the institutional review board of each participating hospital.

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Informed consent was obtained from the patients prior to study participation.

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Salimi, H., Takahashi, S., Hoshino, M. et al. Risk Factors for Residual Back Pain After Balloon Kyphoplasty for Osteoporotic Vertebral Fracture. JOIO (2024). https://doi.org/10.1007/s43465-024-01115-5

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