Multifactor Analysis Of Costal Pain In Osteoporotic Fracture Of Thoracic Vertebra

Objectives:The costal pain is common in thoracic osteoporotic fracture patients.It is unclear why vertebral fracture patients without any specific nerve impingement on MRI present with costal pain.The aim of this study was to investigate the potential causes of costal pain in patients with osteoporotic fracture of thoracic vertebra.Methods:In this retrospective study,100 patients with thoracic osteoporotic fracture were collected and assigned into two groups on the basis of pain patterns noted during medical history and physical examination.Group A comprised 50 patients with costal pain.Group B comprised 50 patients without costal pain.The Visual Analogue Scale(VAS)and Oswestry Disability Index(ODI)scores were recorded to assess the pattern and severity of pain.The sex,age,presence or absence of trauma,time of fracture,fracture segments,and analgesic application were recorded.CT data including changes in fracture vertebral body shape(height,width and length),changes in intervertebral foramen shape(height and width),wedge shape of fractured vertebral body and local kyphosis angle were recorded.The fracture edema signal was determined by magnetic resonance imaging(MRI).Multivariate analysis was performed for all the above parameters.Results:1.Genral conditionsThe average ages in the costal and non-costal groups were 68.8±6.9 and 69.8±9.0 years,respectively.In both groups,the lower thoracic segment(T10-T12)was the most common level of fracture site.There was significant difference in trauma or not,analgesic or not and Visual Analogue Scale between the two groups(P<0.05).No statistical significance in the fracture level,magnetic resonance edema signal size,classification of fracture types,symptom duration or Oswestry Disability Index(P>0.05)were observed between the two groups.2.Comparison of vertebral morphology parametersThere was significant difference in vertebral fracture width,anterior and middle height between the two groups(P<0.05).While there was no significant difference in vertebral length or posterior height(P>0.05).There was significant difference in width of left upper intervertebral foramen or width of right upper intervertebral foramen between the two groups(P<0.05).There was no significant difference in the other parameters of the intervertebral foramen between the two groups(P>0.05).No significant difference in the wedge angle and local kyphosis angle was observed between the two groups(P>0.05).3.The correlation between costal pain and different parameters between the two groupsOur T-test or Chi-square test results showed significant differences in the changes of the vertebral fracture width,anterior and middle height,the width of left and right upper intervertebral foramen,trauma or not,analgesic or not and Visual Analogue Scale(VAS)between the two groups.To further analyze the correlation of the eight factors,binary Logistic regression analysis was conducted.Binary Logistic regression analysis showed that the change of the vertebral body width was a constant significant predictor of costal pain for all patients(P=0.00,Exp(B)=4.531E+50).Following binary Logistic regression analysis,the other seven factors were no longer predictors of costal pain(P>0.05).The incidence of costal pain was higher in patients with increased fracture vertebral width after adjusting for the other seven factors in binary Logistic regression model.Conclusion:1.The vertebral width in patients with costal pain was significantly higher than that without costal pain(P<0.05).The incidence of costal pain is significantly and positively associated with the width of the fractured vertebra in patients with osteoporotic thoracic vertebrae fracture.2.The costal pain is common in patients with osteoporotic fracture of thoracic vertebra.For patients with thoracic osteoporotic fracture,pain location may not accurately reflect the fracture site.Both physical examination and radiological image analysis are required for correct diagnosis.Thus,for aged patients with the pain radiating to both or one side along the intercostal space or to the chest,their thoracic vertebra should be examined,regardless of their trauma history in this region.Significance:The relationship between costal pain and fracture morphology has not been previously reported,we believe that our classification of pain pattern may be useful in finding the pain sources from OVCFs,and hence facilitate in the pain management of these patients.We are also conducting a prospective study to further confirm the reliability of this conclusion.We believe that this study may further elucidate the mechanism of non-midline pain in osteoporotic fractures of the spine.