J Korean Med Sci.  2008 Dec;23(6):1005-1010. 10.3346/jkms.2008.23.6.1005.

Clinical Relevance of Pain Patterns in Osteoporotic Vertebral Compression Fractures

• Doo TH
• Shin DA
• Kim HI
• Shin DG
• Kim HJ
• Chung JH
• Lee JO

• KMID: 1107525
• DOI: http://doi.org/10.3346/jkms.2008.23.6.1005

Abstract

Few studies have been conducted to explain the pain patterns resulting from osteoporotic vertebral compression fractures (OVCF). We analyzed pain patterns to elucidate the pain mechanism and to provide initial guide for the management of OVCFs. Sixty-four patients underwent percutaneous vertebroplasty (N=55) or kyphoplasty (N=9). Three pain patterns were formulized to classify pains due to OVCFs: midline paravertebral (Type A), diffuse paravertebral (Type B), and remote lumbosacral pains (Type C). The degree of compression was measured using scale of deformity index, kyphosis rate, and kyphosis angle. Numerical rating scores were serially measured to determine the postoperative outcomes. As vertebral body height (VBH) decreased, paravertebral pain became more enlarged and extended anteriorly (p<0.05). Type A and B patterns significantly showed the reverse relationship with deformity index (p<0.05), yet Type C pattern was not affected by deformity index. Postoperative pain severity was significantly improved (p<0.05), and patients with a limited pain distribution showed a more favorable outcome (p<0.05). The improvement was closely related with the restoration of VBH, but not with kyphosis rate or angle. Thus, pain pattern study is useful not only as a guide in decision making for the management of patients with OVCF, but also in predicting the treatment outcome.

Keyword

Spinal Pain; Osteoporosis; Compression Fracture; Vertebroplasty; Kyphoplasty

MeSH Terms

Aged
Aged, 80 and over
Female
Fracture Fixation, Internal/methods
Fractures, Compression/etiology/radiography/*surgery
Humans
Kyphosis/therapy
Magnetic Resonance Imaging
Male
Middle Aged
Osteoporosis/*complications/diagnosis
Pain/etiology/*surgery
Pain Measurement
Pain, Postoperative/etiology
Polymethyl Methacrylate/administration & dosage/therapeutic use
Questionnaires
Sickness Impact Profile
Spinal Fractures/radiography/*surgery
Tomography, X-Ray Computed
Treatment Outcome

Figure

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  Fig. 1 Pain patterns in the patients with OVCFs. Type A shows the pain distribution in the paravertebral area mostly localized to midline. Type B shows the diffuse extension of paravertebral pain. Extension of paravertebral pain confined posterior back in Type B1. Pain is extended into the anterior chest in Type B2. Type C indicates the low back pain or lumbosacral pain remote from the site of the lesion.

• 

  Fig. 2 Diagram demonstrating the distribution of the pain patterns in the patients with OVCFs in this study.

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  Fig. 3 Relationship between deformity index and pain patterns. As deformity index decreased, the extent of pain distribution was enlarged. Type A and B patterns significantly showed the reverse relationship with deformity index (p<0.05). Type C pattern was not affected by deformity index. *, p<0.05.

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  Fig. 4 Change of pain severity at 6 months following PVP or PKP. Augmentation of OVCFs significantly reduced pain in all the patients. NRS, numerical rating score.

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  Fig. 5 Change of deformity index after augmentation of OVCFs. Note the improvement of deformity index in all the pain patterns. *, p<0.05.

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  Fig. 6 Change of pain severity in relation to change of deformity index following the augmentation of OVCFs. Pain severity was markedly improved with the increase of deformity index (p<0.05). NRS, numerical rating score; DI, deformity index.

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