Multifactor Analysis of Costal Pain in Osteoporotic Fracture of Thoracic Vertebra

Abstract

BACKGROUND: The costal pain is common in thoracic osteoporotic fracture patients. It is unclear why vertebral fracture patients without any specific nerve impingement on magnetic resonance imaging (MRI) present with costal pain. OBJECTIVES: The aim of this study was to investigate the potential causes of costal pain in patients with osteoporotic fracture of thoracic vertebra. STUDY DESIGN: A retrospective study. SETTING: Shandong province, China. METHODS: In this retrospective study, 100 patients with thoracic osteoporotic fractures were collected and assigned into 2 groups on the basis of pain patterns noted during medical history and physical examination. Group A was comprised of 50 patients with costal pain. Group B was comprised of 50 patients without costal pain. The Visual Analog Scale and Oswestry Disability Index scores were recorded to assess the pattern and severity of pain. The gender, age, presence or absence of trauma, time of fracture, fracture segments, and analgesic application were recorded. Computed tomography data including changes in fracture vertebral body shape (height, width, and length), 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 MRI. Multivariate analysis was performed for all the above parameters. RESULTS: There was a statistically significant difference in the vertebral body width between the 2 groups. LIMITATIONS: The number of patients enrolled is not large enough. We also have limitations in interpreting all pains resulting from osteoporotic vertebral compression fractures, because all pain mechanisms are not fully understood. Further work is needed to improve the accuracy of locating pain sources and distinguishing pain patterns which may result from other spinal structures. CONCLUSION: The incidence of costal pain is significantly and positively associated with the width of the fractured vertebra in patients with osteoporotic thoracic vertebrae fracture. KEY WORDS: Osteoporosis fracture; thoracic vertebrae; costal pain; nonmidline pain; intervertebral foramen; sympathetic nerve