Skip to main content
Download PDF

Thoracolumbar fascia injury in osteoporotic vertebral fracture: the important concomitant damage

BMC Musculoskeletal Disorders volume 24, Article number: 166 (2023) Cite this article

Abstract

Background

Thoracolumbar fascia injury (FI) is rarely discussed in osteoporotic vertebral fracture (OVF) patients in previous literature and it is usually neglected and treated as an unmeaning phenomenon. We aimed to evaluate the characteristics of the thoracolumbar fascia injury and further discuss its clinical significance in the treatment of kyphoplasty for osteoporotic vertebral fracture (OVF) patients.

Methods

Based on the presence or absence of FI, 223 OVF patients were divided into two groups. The demographics of patients with and without FI were compared. The visual analogue scale and Oswestry disability index scores were compared preoperatively and after PKP treatment between these groups.

Results

Thoracolumbar fascia injuries were observed in 27.8% of patients. Most FI showed a multi-level distribution pattern which involved a mean of 3.3 levels. Location of fractures, severity of fractures and severity of trauma were significantly different between patients with and without FI. In further comparison, severity of trauma was significantly different between patients with severe and non-severe FI. In patients with FI, VAS and ODI scores of 3 days and 1 month after PKP treatment were significantly worse compared to those without FI. It showed the same trend in VAS and ODI scores in patients with severe FI when compared to those patients with non-severe FI.

Conclusions

FI is not rare in OVF patients and presents multiple levels of involvement. The more serious trauma suffered, the more severe thoracolumbar fascia injury presented. The presence of FI which was related to residual acute back pain significantly affected the effectiveness of PKP in treating OVFs.

Trial registration

retrospectively registered.

Peer Review reports

Background

Osteoporosis has become a major public health problem worldwide as an aging society is coming [1]. Osteoporotic vertebral fracture (OVF) characterized by significant back pain and limited mobility is one of the most severe complications of osteoporosis [2,3,4]. Different from traumatic spinal fractures in young adults, OVF is always caused by low energy trauma, even though patients did not present any trauma history [5]. Magnetic resonance imaging (MRI) is most effective in detecting OVF which typically presents bone marrow edema within the vertebral body [6]. However, in our clinical practice, except for bone edema, posterior fascia edema was also usually presented in several patients. Thoracolumbar fascia edema with extensive or localized areas indicated posterior peri-vertebral soft tissue injury. Such fascia injury (FI), however, is rarely discussed in OVF patients in previous literatures. To date, the clinical characteristics of such patients and features of thoracolumbar fascia injury are still unclear.

Vertebral augmentation techniques, known as percutaneous kyphoplasty (PKP) or vertebroplasty (PVP), have been widely used to treat OVF in recent years. To date, controversy still exists considering vertebroplasty in addressing acute pain caused by OVF. High- to moderate- quality evidence showed that compared to sham procedure, vertebroplasty presented no important benefit in terms of pain, disability and quality of life in the treatment of acute or subacute OVF [7, 8]. In contrast, a number of studies reported that vertebroplasty and kyphoplasty should be the best choice in treating OVF. Significant pain relief and early mobilization could be achieved after PKP or PVP [9,10,11,12]. However, several patients still presented residual thoracolumbar back pain after vertebral augmentation surgery [13, 14]. Rib fracture, subsequent new vertebral fracture, osteoporotic ostalgia, and other factors were reported to be related to residual pain after PKP or PVP [15, 16]. Thoracolumbar fascia injury which indicated posterior vertebral soft tissue damage should be a potentially crucial factor for residual back pain [15, 17]. Nonetheless, it is rarely discussed whether thoracolumbar fascia injury is closely related to residual back pain and whether fascia injury will affect the therapeutic effect of PKP or PVP in treating OVF is not yet clear. Thus, we performed this study to describe the characteristics of fascia injury in OVF patients and further evaluate its clinical significance in OVF patients treated by vertebral augmentation techniques. 

Methods

Study population

This was a retrospective study approved by the Institutional Review Board of The First Affiliated Hospital of Soochow University, and informed consent was obtained from all patients.

Between January 2019 to December 2020, 223 patients (185 females and 38 males) who were diagnosed as single level OVF and treated by PKP surgery in our institution were included in this study. The included patients were classified into two groups according to the presence or absence of fascia injury (With-FI group and Without-FI group). The average age of the patients was 70.35 ± 8.34 years (ranging from 55 to 93 years).

Inclusion criteria: 1) bone marrow edema in the affected vertebra with or without posterior fascia injury in MR images; 2) severe back pain unresponsive to conservative treatment for at least one week; 3) T-scores assessed by Dual Energy X-ray Absorptiometry was less than -2.5.

Exclusion criteria: 1) pathological fracture secondary to infection or malignancy; 2) unable to tolerate the operation; 3) severe OVF presented fracture dislocation; 4) neurological deficit caused by OVF; 5) combined with Alzheimer's disease or other diseases which made the patients unable to finish information collection on their own.

The time interval between fracture and PKP surgery was recorded as fracture age. The OVF related trauma history was evaluated and the severity of trauma was divided into three degrees (none or minor, moderate, and severe). Vertebral fractures caused by coughing, twisting waist, and other daily activities were considered minor trauma. Moderate trauma was defined as stumble, falls from chairs, and other minor accidents caused by definite external forces. Serious trauma was referred to car accidents, falls from high places and other damages caused by severe external forces.

Surgical procedure

PKP surgeries were performed under general anesthesia in the prone position according to the standard procedure reported in the previous study [18]. After fracture reduction by the inflatable balloon expansion and then polymethylmethacrylate (PMMA) cement was injected into the vertebral body under fluoroscopic guidance to stabilize the fractured vertebrae. Patients were allowed to ambulate one day after surgery. Anti-osteoporotic medications, including calcium, vitamin D3 and bisphosphonates, were routinely used in all the including patients during follow-up time.

Clinical and radiological evaluation

Symptoms of pain were assessed by Visual analogue scale (VAS) scores and patients’ function was evaluated by Oswestry disability index (ODI) scores. VAS scores ranged from zero to ten grades which zero grade indicating no pain at all and ten grade indicating unbearable and drastic pain. Sexual function was eliminated when ODI score evaluation was performed. Results were recorded preoperatively, three days after surgery, one month, three months after surgery, and at the last follow-up.

The involved location of the fracture was assessed according to preoperative MR and X-ray images. The fracture location was recorded as thoracic (T5-T10), thoracolumbar (T11-L2), or lower lumbar region (L3-L5). Fracture severity which was divided into four degrees was assessed by the method of Genant et al. [19]. Thoracolumbar fascia injury was defined based on MR findings of fascia edema and focal tenderness on physical examination in the corresponding level of fascia edema. Two senior surgeons independently evaluated the MR images in PACS system (Neusoft Inc., Shenyang, Liaoning, China) and the final decision was made through consensus discussion in case of disagreement. The radiological features of FI were analyzed mainly on the three most central slices of the sagittal MR images. The involved locations of FI were recorded as thoracolumbar (T11-L2), lower lumbar (L3-L5), or both thoracolumbar and lower lumbar regions. The length of the fascia edema signal was recorded by calculating the number of involved levels of FI. Then patients with FI were further divided into Non-severe (≤ three levels) and Severe (> three levels) FI groups (Figs. 1 and 2).

Fig. 1
figure 1

Osteoporotic vertebral fracture with non-severe fascia injury. Three most central slices of sagittal T1-weighted (A), T2-weighted (B) and T2-weighted fat suppression (C) MR images show L2 vertebral fracture with non-severe FI

Full size image
Fig. 2
figure 2

Osteoporotic vertebral fracture with severe fascia injury. Three most central slices of sagittal T1-weighted (A), T2-weighted (B) and T2-weighted fat suppression (C) MR images show L1 vertebral fracture with severe FI

Full size image

Statistical analysis

The differences between the groups (With-FI vs. Without-FI; Non-severe FI vs. Severe FI) were compared by the t test or Mann–Whitney U test for continuous variables and Chi-square test for categorical variables. Paired t test or Wilcoxon signed-rank test was used to compare the differences at different follow-up time. The probability value of less than 0.05 was considered statistically significant. SPSS 19.0 software (SPSS Inc, Chicago, IL, USA) was used to perform the statistical analysis.

Results

The demographic data of the included patients were listed in Table 1. In this study, 62 patients were detected with fascia injury (With-FI group) while 161 patients had no fascia injury (Without-FI group) according to the preoperative MR images which represented that the incidence of FI was 27.8% in our OVF patients. Then, in With-FI group, 23 patients were further classified into Severe FI group and 39 patients were considered as Non-severe FI group based on severity of FI. All PKP surgeries were performed successfully without severe complications (Fig. 3). Patients were followed up for 17.27 ± 5.19 months on average.

Table 1 Demographic data for With-FI group and Without-FI group
Full size table
Fig. 3
figure 3

A 59-year-old female patient with back pain for 10 days. The T1-weighted, T2-weighted and T2-weighted fat suppression MR images (A) show L1 vertebral fracture with severe FI. Preoperative anteroposterior (B) and lateral (C) X-ray images show L1 and T12 vertebral compression. Postoperative anteroposterior (D) and lateral (E) X-ray images present satisfactory cement distribution after percutaneous kyphoplasty surgery

Full size image

Most of the fascia injuries showed a multi-level distribution pattern which involved a mean of 3.3 levels (ranging from one to seven levels) (Fig. 4).

Fig. 4
figure 4

The involved levels of fascia injury in osteoporotic vertebral fracture patients

Full size image

The involved locations of FI were: 21 cases occurred in the lower lumbar region (L3-L5), 5 cases in the thoracolumbar region (T11-L2), and 36 cases involved both thoracolumbar and lower lumbar regions (T11-L5); none was found in the thoracic region (T5-T10) (Fig. 5).

Fig. 5
figure 5

The involved locations of fascia injury in osteoporotic vertebral fracture patients

Full size image

There were no statistically significant differences between patients with FI and those without FI in terms of patients’ age, gender, BMI, BMD, fracture age, and other factors (Table 1).

However, statistically significant differences were detected in fracture location (P = 0.04), severity of fracture (P = 0.01), and severity of trauma (P < 0.001) between the two groups. OVF patients with FI usually suffered more serious trauma than those without FI (48/62, 77.42% vs 54/161, 33.54%; P < 0.001); the severity of fracture was also more serious in With-FI group than that in Without-FI group (8/62, 12.9% vs. 12/161, 7.45%; P = 0.01). In addition, in With-FI group, more fractures were located in lower lumbar region than those in Without-FI group (14/62, 22.58% vs. 18/161, 11.18%; P = 0.04). A comparison between Severe and Non-severe FI groups showed that the severity of trauma in Severe FI group was much more serious than that in Non-severe FI group (P < 0.05) (Table 2).

Table 2 Demographic data for None-severe FI group and Severe FI group
Full size table

The preoperative VAS and ODI scores did not differ significantly between With-FI group and Without-FI group. After PKP treatment, both VAS and ODI scores were improved when compared with preoperative values in both groups (Table 3).

Table 3 VAS and ODI scores of OVF patients With and Without FI evaluated before and after PKP surgery
Full size table

However, the VAS and ODI scores three days and one month after surgery were both significantly worse in With-FI group than those values in Without-FI group (P < 0.01). Then there were no statistically significant differences in the VAS and ODI scores between the two groups three months after surgery and at the last follow-up. Further comparison between Severe and Non-severe FI groups showed the VAS and ODI scores were also much worse in Severe FI group than those in Non-severe group three days and one month after surgery (P < 0.05). Then the VAS and ODI scores showed no statistically significant differences three months after surgery and at the last follow-up (Table 4).

Table 4 VAS and ODI scores of OVF patients with Severe and Non-severe FI evaluated before and after PKP surgery
Full size table

Discussion

Osteoporotic vertebral fracture combined with thoracolumbar fascia injury is not a rare phenomenon. In this retrospective study, we found its incidence to be 27.8% (62/223). A recent study by Wang et al. [15] described fascia injury in 7.4% (16/215) of the patients with OVF. In another prospective cohort study by Yan et al. [11], they evaluated the cause of residual back pain after vertebroplasty and they reported that the prevalence of fascia injury was as high as 42.1%. Thus, FI should be considered common complicated damage in OVF patients which is usually neglected in clinical work.

Thoracolumbar fascia is a complex arrangement of layers of fascia and aponeurosis, located in the thoracic and lumbar segments of the spine. Thoracolumbar fascia plays an important biomechanical role in maintaining the stability of the lumbar spine and pelvis and the damaged fascia usually caused local back pain [20]. In this study, FI mainly occurred in thoracolumbar vertebral fracture patients and FI tends to occur in lower lumbar region or extend from thoracolumbar to lower back region which may be attributed to the protective mechanism of the fascia under spinal trauma and downward transmission of spinal mechanical load [21, 22]. The lower lumbar fascia injury may partially explain the interesting phenomenon that several osteoporotic thoracolumbar vertebral facture (T11-L2) patients usually complain of distal lumbosacral pain which is still vague in previous literatures [23].

OVFs are mostly caused by minor trauma or even no trauma due to the significant loss of vertebral bone quality and quantity [24, 25]. However, as presented in this study, when OVF is combined with FI, these patients would generally suffer from moderate or more serious trauma. Furthermore, the severity of fracture was also related to the occurrence of FI in this study. We further found that most FI showed a multi-level distribution pattern (a mean of 3.3 levels) and the severity of FI (> 3 levels) was positively correlated with the degree of trauma. These could be explained that the more serious trauma the patients suffered, the more severe fracture and fascia injury would develop. Thoracolumbar fascia injury should be considered an indicator of serious trauma and severe vertebral fracture in OVF patients.Furthermore, it is interesting that for those OVFs with FI, more fractures were located in lower lumbar region than those without FI (22.58% vs. 11.18%) in this study. This may be explained to the fact that osteoporotic lower lumbar fractures are usually caused by more severe trauma which has a higher risk of developing fascia injury [26].

Though there was controversy in the past, PKP is becoming the standard procedure for the treatment of OVFs nowadays [8, 9, 11, 27, 28]. By stabilizing the fractured vertebra using bone cement, significant pain relief and early mobilization could be achieved after surgery. However, a portion of patients still complained of residual back pain after PKP or PVP surgery and were considered unsatisfied about being performed surgery [15, 29]. According to the literatures, residual back pain was rarely discussed and unsatisfactory cement distribution, severe paraspinal muscle degeneration or fascia injury, and depression were reported to be the risk factors for residual back pain [15, 16, 30]. A previous study reported that OVFs with concomitant thoracolumbar FI did not respond well to vertebral augmentation surgeries, indicating that FI should be related to residual back pain [17]. In our study, the postoperative VAS and ODI scores were both significantly worse in OVF patients with FI than those without FI (P < 0.05), which indicated that the presence of FI affected the effectiveness of PKP in treating OVFs. Further comparison between Severe and Non-severe FI groups presented that the more severe injury of thoracolumbar fascia (> 3 levels), the more significant residual pain would have. The plausible explanation for these results is that the thoracolumbar fascia is abundant in nerve endings [15]; though vertebral augmentation surgeries stabilized fractured vertebra and relieved fracture related pain, however, the damaged fascia and soft tissue edema was the other painful source of low back pain.

There were several limitations in this study. First, the severity of trauma was not defined quantitatively and subjective bias might exist based on the recount from patients. Second, we defined fascia injury as the high intensity lesion around fascia in MR images which may not be accurately indicate fascial fiber injury. Third, the mechanism of occurrence of fascia injury in OVF patients could not be elucidated in this study. Further biomechanical studies and finite element analysis should be performed to explain it. Furthermore, the degeneration of paraspinal muscle which was not evaluated in this study might be another factor that related to the severity of fascia injury in OVF patients [31, 32]. Further prospective controlled studies are needed to further explore the clinical significance of fascia injury in OVF patients treated by PKP or PVP due to the retrospective nature of this study.

Conclusions

Thoracolumbar fascia injury is not rare and should be regarded as important concomitant damage in OVF patients. FI is mainly located in the lower lumbar region with multiple levels involved. The more serious trauma suffered, the more severe thoracolumbar fascia injury presented. The presence of FI which was related to residual back pain significantly affected the effectiveness of PKP in treating OVFs.

Availability of data and materials

Data and materials included in the study are available from the corresponding author on request.

Abbreviations

OVF:

Osteoporotic vertebral fracture

FI:

Fascia injury

MRI:

Magnetic resonance imaging

PKP:

Percutaneous kyphoplasty

PVP:

Percutaneous vertebroplasty

VAS:

Visual analogue scale

ODI:

Oswestry disability index

References

  1. Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006;17(12):1726–33.

    Article  CAS  PubMed  Google Scholar 

  2. Lau E, Ong K, Kurtz S, Schmier J, Edidin A. Mortality following the diagnosis of a vertebral compression fracture in the Medicare population. J Bone Joint Surg Am. 2008;90(7):1479–86.

    Article  PubMed  Google Scholar 

  3. Ong KL, Beall DP, Frohbergh M, Lau E, Hirsch JA. Were VCF patients at higher risk of mortality following the 2009 publication of the vertebroplasty “sham” trials? Osteoporos Int. 2018;29(2):375–83.

    Article  CAS  PubMed  Google Scholar 

  4. Hoffmann RT, Jakobs TF, Trumm C, Weber C, Glaser C, Reiser MF. Vertebroplasty in the treatment of osteoporotic vertebral body fracture. Eur Radiol. 2007;17(10):2656–62.

    Article  CAS  PubMed  Google Scholar 

  5. Li F, Eckstrom E, Harmer P, Fitzgerald K, Voit J, Cameron KA. Exercise and Fall Prevention: Narrowing the Research-to-Practice Gap and Enhancing Integration of Clinical and Community Practice. J Am Geriatr Soc. 2016;64(2):425–31.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Spiegl UJ, Beisse R, Hauck S, Grillhosl A, Buhren V. Value of MRI imaging prior to a kyphoplasty for osteoporotic insufficiency fractures. Eur Spine J. 2009;18(9):1287–92.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Buchbinder R, Johnston RV, Rischin KJ, Homik J, Jones CA, Golmohammadi K, et al. Percutaneous vertebroplasty for osteoporotic vertebral compression fracture. Cochrane Database Syst Rev. 2018;11(11):CD006349.

    PubMed  Google Scholar 

  8. Firanescu CE, de Vries J, Lodder P, Venmans A, Schoemaker MC, Smeets AJ, et al. Vertebroplasty versus sham procedure for painful acute osteoporotic vertebral compression fractures (VERTOS IV): randomised sham controlled clinical trial. BMJ. 2018;361:k1551.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Klazen CAH, Lohle PNM, de Vries J, Jansen FH, Tielbeek AV, Blonk MC, et al. Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial. The Lancet. 2010;376(9746):1085–92.

    Article  Google Scholar 

  10. He Z, Zhai Q, Hu M, Cao C, Wang J, Yang H, et al. Bone cements for percutaneous vertebroplasty and balloon kyphoplasty: Current status and future developments. J Orthop Translat. 2015;3(1):1–11.

    Article  CAS  PubMed  Google Scholar 

  11. Yang H, Chen L, Zheng Z, Yin G, Lu WW, Wang G, et al. Therapeutic effects analysis of percutaneous kyphoplasty for osteoporotic vertebral compression fractures: A multicentre study. J Orthop Translat. 2017;11:73–7.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Bornemann R, Hanna M, Kabir K, Goost H, Wirtz DC, Pflugmacher R. Continuing conservative care versus crossover to radiofrequency kyphoplasty: a comparative effectiveness study on the treatment of vertebral body fractures. Eur Spine J. 2012;21(5):930–6.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Rodriguez AJ, Fink HA, Mirigian L, Guanabens N, Eastell R, Akesson K, et al. Pain, Quality of Life, and Safety Outcomes of Kyphoplasty for Vertebral Compression Fractures: Report of a Task Force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2017;32(9):1935–44.

    Article  PubMed  Google Scholar 

  14. Lin CC, Shen WC, Lo YC, Liu YJ, Yu TC, Chen IH, et al. Recurrent pain after percutaneous vertebroplasty. AJR Am J Roentgenol. 2010;194(5):1323–9.

    Article  PubMed  Google Scholar 

  15. Li Y, Yue J, Huang M, Lin J, Huang C, Chen J, et al. Risk factors for postoperative residual back pain after percutaneous kyphoplasty for osteoporotic vertebral compression fractures. Eur Spine J. 2020;29(10):2568–75.

    Article  PubMed  Google Scholar 

  16. Lin CC, Wen SH, Chiu CH, Chen IH, Yu TC. The clinical influence of fluid sign in treated vertebral bodies after percutaneous vertebroplasty. Radiology. 2009;251(3):866–72.

    Article  PubMed  Google Scholar 

  17. Yan Y, Xu R, Zou T. Is thoracolumbar fascia injury the cause of residual back pain after percutaneous vertebroplasty? A prospective cohort study. Osteoporos Int. 2015;26(3):1119–24.

    Article  CAS  PubMed  Google Scholar 

  18. Zou J, Mei X, Gan M, Wang G, Lu J, Yang H. Is kyphoplasty reliable for osteoporotic vertebral compression fracture with vertebral wall deficiency? Injury. 2010;41(4):360–4.

    Article  PubMed  Google Scholar 

  19. Genant HK, Wu CY, van Kuijk C, Nevitt MC. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res. 1993;8(9):1137–48.

    Article  CAS  PubMed  Google Scholar 

  20. Willard FH, Vleeming A, Schuenke MD, Danneels L, Schleip R. The thoracolumbar fascia: anatomy, function and clinical considerations. J Anat. 2012;221(6):507–36.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Wilke J, Schleip R, Klingler W, Stecco C. The Lumbodorsal Fascia as a Potential Source of Low Back Pain: A Narrative Review. Biomed Res Int. 2017;2017:5349620.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Lariviere C, Henry SM, Preuss R. Structural remodeling of the lumbar multifidus, thoracolumbar fascia and lateral abdominal wall perimuscular connective tissues: A search for its potential determinants. J Anat. 2021;238(3):536–50.

    Article  CAS  PubMed  Google Scholar 

  23. Niu J, Song D, Gan M, Liu B, Tan C, Yang H, et al. Percutaneous kyphoplasty for the treatment of distal lumbosacral pain caused by osteoporotic thoracolumbar vertebral fracture. Acta Radiol. 2018;59(11):1351–7.

    Article  PubMed  Google Scholar 

  24. Hinde K, Maingard J, Hirsch JA, Phan K, Asadi H, Chandra RV. Mortality Outcomes of Vertebral Augmentation (Vertebroplasty and/or Balloon Kyphoplasty) for Osteoporotic Vertebral Compression Fractures: A Systematic Review and Meta-Analysis. Radiology. 2020;295(1):96–103.

    Article  PubMed  Google Scholar 

  25. Luthman S, Widen J, Borgstrom F. Appropriateness criteria for treatment of osteoporotic vertebral compression fractures. Osteoporos Int. 2018;29(4):793–804.

    Article  CAS  PubMed  Google Scholar 

  26. Niu J, Feng T, Huang C, Yan Q, Song D, Gan M, et al. Characteristics of Osteoporotic Low Lumbar Vertebral Fracture and Related Lumbosacral Sagittal Imbalance. Orthopedics. 2021;44(1):e7–12.

    Article  PubMed  Google Scholar 

  27. Hochmuth K, Proschek D, Schwarz W, Mack M, Kurth AA, Vogl TJ. Percutaneous vertebroplasty in the therapy of osteoporotic vertebral compression fractures: a critical review. Eur Radiol. 2006;16(5):998–1004.

    Article  CAS  PubMed  Google Scholar 

  28. Xie L, Zhao ZG, Zhang SJ, Hu YB. Percutaneous vertebroplasty versus conservative treatment for osteoporotic vertebral compression fractures: An updated meta-analysis of prospective randomized controlled trials. Int J Surg. 2017;47:25–32.

    Article  PubMed  Google Scholar 

  29. Ma Y, Wu X, Xiao X, Ma Y, Feng L, Yan W, et al. Effects of teriparatide versus percutaneous vertebroplasty on pain relief, quality of life and cost-effectiveness in postmenopausal females with acute osteoporotic vertebral compression fracture: A prospective cohort study. Bone. 2020;131:115154.

    Article  CAS  PubMed  Google Scholar 

  30. Li Q, Shi L, Wang Y, Guan T, Jiang X, Guo D, et al. A Nomogram for Predicting the Residual Back Pain after Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures. Pain Res Manag. 2021;2021:3624614.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Huang CWC, Tseng IJ, Yang SW, Lin YK, Chan WP. Lumbar muscle volume in postmenopausal women with osteoporotic compression fractures: quantitative measurement using MRI. Eur Radiol. 2019;29(9):4999–5006.

    Article  PubMed  Google Scholar 

  32. Luo Y, Jiang T, Guo H, Lv F, Hu Y, Zhang L. Osteoporotic vertebral compression fracture accompanied with thoracolumbar fascial injury: risk factors and the association with residual pain after percutaneous vertebroplasty. BMC Musculoskelet Disord. 2022;23(1):343.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

Not applicable.

Funding

This study was supported by the National Natural Science Foundation of China (grant no. 81902181).

Author information

Author notes

  1. Zicheng Deng Tao Feng and Xiexing Wu contributed equally to this work.

Authors and Affiliations

  1. The authors are from the Department of Orthopaedic Surgery, the First Affiliated Hospital of Soochow University, NO. 899, Pinghai Road, Suzhou, 215006, Jiangsu, China

    Zicheng Deng, Tao Feng, Xiexing Wu, Haifeng Xie, Dawei Song, Jinning Wang, Huilin Yang & Junjie Niu

Authors
  1. Zicheng Deng
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tao Feng
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xiexing Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Haifeng Xie
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dawei Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jinning Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Huilin Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Junjie Niu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Junjie Niu and Huilin Yang contributed to the study conception and design. The material preparation, data collection and analysis were performed by Zicheng Deng and Tao Feng. The statistical analysis was performed by. Xiexing Wu, Haifeng Xie, Dawei Song and Jinning Wang. The first draft of the manuscript was written by Zicheng Deng and Junjie Niu. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Huilin Yang or Junjie Niu.

Ethics declarations

Ethics approval and consent to participate

This study was an observational study using the data of patients admitted to the Department of Orthopedics, First Affiliated Hospital of Soochow University, Suzhou, China. This study was approved by the Institutional Ethics Committee of First Affiliated Hospital of Soochow University (No. 2022175). Informed consent was obtained from all participants enrolled in this study. The study was carried out in accordance with relevant guidelines and regulations.

Consent for publication

Not applicable.

Competing interests

The authors declare that there is no conflict of interest regarding the publication of this paper.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Deng, Z., Feng, T., Wu, X. et al. Thoracolumbar fascia injury in osteoporotic vertebral fracture: the important concomitant damage. BMC Musculoskelet Disord 24, 166 (2023). https://doi.org/10.1186/s12891-023-06280-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12891-023-06280-6

Keywords

BMC Musculoskeletal Disorders

ISSN: 1471-2474

Contact us