Analysis of influential factors for residual low back pain in older adult patients with osteoporotic thoracolumbar compression fractures after surgery and construction of a predictive model
Objective To analyze the factors associated with residual low back pain in older adults with osteoporotic thoracolumbar compression fractures after surgery,and to construct a predictive model based on the collected data and assess its effectiveness.Methods The clinical data of 101 older adult patients with osteoporotic thoracolumbar compression fractures who underwent surgical treatment at Xi'an International Medical Center Hospital from January 2020 to December 2022 were retrospectively analyzed.The patients were divided into two groups based on the presence or absence of low back pain after surgery:those with low back pain and those without.Postoperative pain intensity was recorded in detail.Univariate and multivariate analyses were performed to identify independent influential factors.In addition,a predictive model was constructed and its accuracy and prediction ability were tested.Results Among 101 patients with osteoporotic thoracolumbar compression fractures,43(42.57％)experienced low back pain after surgery,while 58(57.43％)did not.Univariate analysis revealed that patients with low back pain were older compared with those without low back pain[(67.81±3.65)years vs.(64.21±3.11)years,t=5.34].Patients with low back pain had a higher level of education,with 62.79％holding a college degree or higher compared to 41.38％of patients without low back pain(x2=4.52).The prevalence of psychological disorders was higher in patients with low back pain compared with those without low back pain(39.53％vs.20.69％,x2=4.28),as was the proportion of patients who smoke(34.88％vs.13.79％,x2=6.25).Additionally,the proportion of patients with a history of fractures was greater in patients with low back pain compared with those without low back pain(25.58％vs.10.34％,x2=4.09).The bone density in patients with low back pain was lower than that in patients without low back pain[(3.18±0.48)g/cm3 vs.(3.67±0.43)g/cm3,t=-5.38].The American Society of Anesthesiologists(ASA)classification was also higher in patients with low back pain,with proportions of ASA Ⅰ,Ⅱ,Ⅲ,and Ⅳ being 18.60％,25.58％,32.56％,and 23.26％compared with 34.48％,37.93％,20.69％,and 6.90％in patients without low back pain(x2=9.51).The volume of bone cement injected was lower in patients with low back pain than in those without low back pain[(4.62±0.21)mL vs.(4.85±0.18)mL,t=-5.91].The incidence of cement leakage was higher in patients with low back pain than in those without low back pain(18.60％vs.1.72％,x2=6.71).All differences were statistically significant(all P＜0.05).Multivariate logistic regression analysis indicated that age and cement leakage were independent risk factors for residual low back pain(OR=1.634,3.379,both P＜0.05),while bone density and the amount of injected cement were protective factors against residual low back pain(OR=0.017,0.003,both P＜0.05).Model validation showed that the regression model had good fit(Hosmer-Lemeshow x2=6.73,P＞0.05).A risk prediction model was constructed based on the selected variables,yielding a C-index of 0.792.Using the independent variables and P values,a receiver operating characteristic curve was generated to predict the likelihood of low back pain in patients,with areas under the curve of 0.749,0.754,0.754,0.642,and 0.945,respectively.Conclusion Residual low back pain after surgery in older adult patients with osteoporotic thoracolumbar compression fractures is associated with age,bone density,volume of bone cement injected,and cement leakage.The constructed nomogram model,based on these factors,demonstrates good predictive capability for residual low back pain in this population.
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