Risk factors of residual back pain after vertebral augmentation in osteoporotic vertebral compression fracture patients: a systematic review and meta-analysis.

BACKGROUND: Residual back pain (RBP) following vertebral augmentation negatively impacts clinical satisfaction and compromises both the physical and psychological well-being of affected patients. This meta-analysis aimed to identify risk factors associated with RBP after vertebral augmentation in patients with osteoporotic vertebral compression fractures (OVCF). METHODS: We searched literature in the PubMed, Embase, Web of Science and Cochrane Library. PRISMA guidelines were followed in this review. The Newcastle-Ottawa Scale (NOS) were used to evaluate the quality of included studies. Odds ratio (OR), mean difference (MD) and 95% confidence interval (CI) of potential risk factors were calculated via RevMan5.4. RESULTS: A total of 11 studies and 3290 patients were included in this meta-analysis. 12 risk factors were assessed and the outcome showed that lower BMD (MD = 0.39, 95% CI 0.27 ~ 0.52, p < 0.01), lower BMI (MD = -1.22, 95% CI -2.38 ~ -0.06, p = 0.04), depression (OR = 2.72, 95% CI 1.48 ~ 5.01, p < 0.01), adjacent vertebral fracture (OR = 2.53, 95% CI 1.42 ~ 4.50, p < 0.01), posterior fascia injury (OR = 3.94, 95% CI 3.10 ~ 5.00, p < 0.01), intravertebral vacuum cleft (OR = 2.33, 95% CI 1.56 ~ 3.50, p < 0.01), severe paraspinal muscle degeneration (OR = 6.25, 95% CI 4.09 ~ 9.53, p < 0.01), facet joint violation (OR = 7.71, 95% CI 3.50 ~ 17.00, p < 0.01), unsatisfied bone cement distribution (OR = 2.82, 95% CI 1.67 ~ 4.76, p < 0.01), less bone cement volume (MD = -0.24, 95% CI -0.45 ~ -0.03, p = 0.02), less recovery rate of anterior vertebral height (MD = -3.46, 95% CI -6.22 ~ -6.09, p = 0.01), less postoperative local kyphosis correction rate (MD = -4.74, 95% CI -6.43 ~ -3.06, p < 0.01) were associated with postoperative RBP in OVCF patients. CONCLUSION: Lower BMD, lower BMI, depression, adjacent vertebral fracture, posterior fascia injury, intravertebral vacuum cleft, severe paraspinal muscle degeneration, facet joint violation, unsatisfied bone cement distribution, less bone cement volume, less recovery rate of anterior vertebral height, and less postoperative local kyphosis correction rate were associated with an increased risk of RBP after vertebral augmentation in OVCF patients. Early identification and targeted management of high-risk patients may help reduce RBP incidence.