Percutaneous Vertebroplasty Versus Kyphoplasty for Thoracolumbar Osteoporotic Vertebral Compression Fractures in Patients with Distant Lumbosacral Pain

Background: In clinical practice, we have found that the pain caused by thoracolumbar osteoporoticvertebral compression fracture (OVCF) is sometimes not limited to the level of the fractured vertebraebut instead occurs in areas far away from the injured vertebrae, such as the lower back, areasurrounding the iliac crest, or buttocks, and this type of pain is known as distant lumbosacral pain.The pathogenesis of pain in distant regions caused by thoracolumbar OVCF remains unclear.Objectives: To compare the clinical efficacy and imaging outcomes of percutaneous vertebroplasty(PVP) and percutaneous kyphoplasty (PKP) in the treatment of distant lumbosacral pain accompaniedby thoracolumbar OVCF and to explore the possible pathogenesis of distant lumbosacral pain causedby thoracolumbar OVCF.Study Design: Retrospective study.Setting: A university hospital spinal surgery departments.Methods: A total of 62 patients who underwent vertebral augmentation for thoracolumbarOVCF with lumbosacral pain were included and divided into the PVP group (28 cases) and thePKP group (34 cases). The Visual Analog Scale (VAS) was used to evaluate the severity of local anddistant lumbosacral pain, and the Chinese modified Oswestry Disability Index (CMODI) was usedfor functional assessment. The anterior vertebral height (AVH) of the fractured vertebrae and localkyphotic angle were measured on plain radiographs. The average follow-up time was 28.62 ± 8.43months in the PVP group and 29.22 ± 9.09 months in the PKP group.Results: Within the 2 groups, the VAS score of local pain, VAS score of distant lumbosacral pain,and CMODI score at 3 days postoperatively and at the last follow-up improved significantly comparedwith the scores before surgery. However, there was no significant difference between the 2 groups.At 3 days postoperatively and at last follow-up, the AVH and Cobb angle in the 2 groups improvedsignificantly compared with those before surgery, but the magnitudes of AVH improvement andCobb angle correction were significantly larger in the PKP group than in the PVP group.Limitations: First, this study is retrospective and may be prone to selection bias. Second, becauseof cultural and linguistic differences, the original version of the Oswestry Disability Index could not beproperly understood and completed by people in mainland China. Therefore in this study, the CMODIwas used, but the correlation coefficients of the CMODI within and between groups were 0.953 and0.912, respectively. Third, a pain diagram was not used to accurately reflect the location of pain inthe distant lumbosacral region.Conclusions: Both PVP and PKP can effectively alleviate pain in the distant lumbosacral regioncaused by thoracolumbar OVCF, and distant lumbosacral pain associated with thoracolumbar OVCFmay be considered vertebrogenic referred pain.Key words: Osteoporotic vertebral compression fracture, distant pain, non-midline pain,kyphoplasty, vertebroplasty, vertebral augmentation, lumbosacral pain, Chinese modified OswestryDisability Index