Risk factors for immediate severe pain in patients with thoracolumbar junction fracture treated with percutaneous pedicle screw fixation: a retrospective study of 598 patients.

backgroundPercutaneous pedicle screw fixation (PPSF) is widely used for thoracolumbar fractures because it is minimally invasive and facilitates early recovery. However, some patients experience marked pain in the ultra-early postoperative period, which may hinder early mobilization and compromise enhanced recovery after surgery (ERAS). This study aimed to identify factors associated with immediate severe pain within 0-8 h after PPSF and to evaluate the discriminatory performance of a multivariable model.

methodsWe retrospectively included 598 consecutive patients with thoracolumbar fractures treated with PPSF at our institution from December 2022 to December 2024. Immediate severe pain was defined as a maximum visual analog scale (VAS) score > 7.0 within 0-8 postoperative hours. Demographic, perioperative, and imaging variables were collected. All patients received a standardized baseline postoperative analgesic regimen, and the analyzed VAS score was recorded before administration of additional rescue analgesics. Standardized preoperative pain scores were not routinely available in this retrospective cohort. Time from injury to surgery was prespecified and retained in the multivariable model as a clinically relevant injury-course variable; however, it was not considered a substitute for baseline pain assessment. Variables with P < 0.10 in univariable analyses and clinically important factors were entered into a multivariable logistic regression model. Model discrimination was assessed using the area under the receiver operating characteristic curve (AUC); the 95% confidence interval (CI) for AUC was estimated using bootstrap resampling.

resultsOf 598 patients, 244 (40.8%) developed immediate severe pain. In multivariable analysis, older age (adjusted odds ratio [aOR] 1.076 per 1 year, 95% CI 1.052-1.100), higher body mass index (BMI) (aOR 1.071 per 1 kg/m

conclusionIn this PPSF-treated cohort of thoracolumbar junction fractures, immediate severe pain was associated with age, BMI, vertebral compression ratio, and FJV, while higher HU values were inversely associated with the outcome. These factors may support perioperative risk stratification and individualized optimization of screw placement strategy and analgesia pathways; however, the findings should be interpreted with caution given the retrospective design and the potential for residual confounding.