ArticleJournal of spine surgery (Hong Kong)2026
Risk factors and management of early pain non-response after vertebroplasty in osteoporotic vertebral compression fractures.
Article in Journal of spine surgery (Hong Kong), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Percutaneous vertebroplasty is widely used to treat painful osteoporotic vertebral compression fractures (OVCFs), providing rapid pain relief in most patients. However, a subset of patients experiences early pain non-response, and the predictors and optimal management of this condition remain incompletely understood. This study aimed to identify risk factors associated with early pain non-response after vertebroplasty and to describe a practical management approach. Methods: We retrospectively reviewed patients with OVCFs who underwent vertebroplasty at a tertiary referral center between January 2023 and December 2025. Pain intensity was assessed using the visual analog scale (VAS). Early pain non-response was defined as a postoperative VAS reduction of <2 points or a VAS score ≥5 within 72 hours after the procedure. Demographic, clinical, radiological, and procedural variables were analyzed using univariate and multivariate logistic regression models. Results: A total of 837 patients were included, of whom 96 (11.5%) experienced early pain non-response after vertebroplasty. Multivariate analysis identified severe vertebral collapse (>50%), presence of an intravertebral cleft, multiple adjacent vertebral fractures, delayed intervention (>6 weeks after symptom onset), and discordance between magnetic resonance imaging (MRI) bone marrow edema and pain location as independent predictors of early pain non-response. Following targeted post-procedural management, including optimized medical therapy, facet joint interventions, repeat vertebral augmentation, or alternative stabilization procedures, 77.1% of non-responders achieved significant short-term pain improvement. Conclusions: Early pain non-response after vertebroplasty is not uncommon and can be predicted using identifiable clinical and imaging factors. A cause-oriented, individualized management approach may improve short-term pain outcomes in patients with persistent pain after vertebroplasty.
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