Association between thoracolumbar fascia injury and residual back pain following percutaneous vertebral augmentation: A systematic review and meta-analysis

Abdiaziz Ahmed Mohamed ^1,2 Xu Xuyang ^1,2 Zhang Zhiqiang ^1* Jianghu Chen ³

• ¹ Department of Orthopedics, Northern Jiangsu People's Hospital, Yangzhou University, Yangzhou, Jiangsu Province, China
• ² Medical College, Yangzhou University, Yangzhou, Jiangsu, China,, Yangzhou, Jiangsu Province, China
• ³ Xuzhou Medical University, Xuzhou City, Jiangsu Province, China, Xuzhou, Jiangsu Province, China

Objective: To evaluate the association between thoracolumbar fascia injury (TLFI) and development of residual back pain (RBP) following percutaneous vertebral augmentation (PVA).Background: Osteoporotic vertebral compression fractures (OVCF) commonly affect elderly individuals and those with osteoporosis, leading to pain and limited mobility. Percutaneous vertebral augmentation provides immediate pain relief and stabilization of the fractures. However, some patients experience residual pain after the treatment. Although recent studies have suggested a potential association, the role of TLFI in RBP remains inconclusive. The aim of this meta-analysis was to evaluate this association.Methods: A thorough search was performed across PubMed, Medline, Embase, Web of Science, and Cochrane Library, databases from inception to December 31, 2024, to identify studies examining the link between TLFI and RBP following PVA. A random-effects model was used to combine the outcome data to account for the potential heterogeneity among the included studies.Results: This meta-analysis included thirteen studies with a total of 4,542 participants with TLFI incidence rate of 28%. Univariate analysis indicated that TLFI patients are significantly more likely to develop RBP compared to those without TLFI, with an odds ratio (OR) of 4.19 (95% CI: 2.49 to 7.05, I² = 76.9%). Sensitivity analysis identified two studies as significant influential outliers. Excluding these studies resulted reduced heterogeneity with OR of 4.62(95% CI: 3.61 to 5.92, I² = 0%). Multivariate analysis confirmed a strong association between TLFI and RBP after adjusting for confounders and other risk factors, with an OR of 4.57 (95% CI: 3.28 to 6.37, I² = 81.5%). Sensitivity analysis identified three studies as significant influential outliers, and excluding them resulted in an OR of 4.79 (95% CI: 3.76 to 6.11, I² = 0%) with no heterogeneity. This finding further confirms the association with a more homogenous overall effect estimate. Conclusion: The pooled effect size of univariate and multivariate analyses consistently showed that TLFI significantly increased the risk of developing RBP after PVA regardless of other related risk factors. Recognizing fascia injury as a potential source of postoperative pain could enhance patient care and mitigate postoperative pain.