Back pain from painful osteoporotic vertebral fractures:​ discrepancy between the actual fracture location and the location suggested by patient-reported pain or physical examination findings

Jin, H.; Ma, X.; Liu, Y.; Liu, M.; Yin, X.; Fan, W.; Zhu, J.; Zhao, J. H.; Chen, L.; Su, N.; Xie, Y.; Yang, J.; Liu, P.

Affiliations

¹Department of Spine Surgery, Center of Orthopedics, Daping Hospital (Army Medical Center of PLA), Army Medical University, Chongqing, China

²Department of Orthopedics and Neurosurgery, Army 954th Hospital, Shannan, China

³Department of Wound Infection and Drug, State Key Laboratory of Trauma, Burns and Combined Injury, Research Institute of Surgery, Daping Hospital (Army Medical Center of PLA), Army Medical University, Chongqing, China

⁴Laboratory for the Rehabilitation of Traumatic Injuries, Center of Bone Metabolism and Repair, State Key Laboratory of Trauma, Burns and Combined Injury, Trauma Center, Research Institute of Surgery, Daping Hospital (Army Medical Center of PLA), Army Medical University, Chongqing, China

Abstract and keywords

Summary: Caution is necessary when using symptom or physical examination findings to localize the osteoporotic vertebral fractures (VFs) attributable to the discrepant colocalized relationship.

Introduction: Whether the location of symptoms or physical examination findings delineates the appropriate spinal range for imaging has not been thoroughly investigated for VFs. The present study aims to analyze the consistency between the fractural vertebrae location and the location suggested by patient-reported pain or physical examination findings.

Methods: This observational study, following a prospective design, enrolled 358 patients with VFs. The locations of two symptoms (patient-reported back pain [P-RBP], radiating pain [RP]) and findings from two physical examinations (spinal palpation tenderness [SPT], axial spinal percussion pain [ASPP]) were used to locate the VF segments identified using whole-spine magnetic resonance imaging (MRI). The percentage of agreements and kappa coefficient were calculated.

Results: In 20.7% (74/358), the P-RBP site and VF segments were in the same location (kappa = 0.153); 21.2% (76/358) presented with concomitant RP in 93.4% (71/76) of whom the RP dermatome was colocalized with the VF segments (kappa = 0.924); 55.0% (197/358) and 23.2% (83/358) of patients presented with positive SPT and ASPP, respectively; and in 49.2% (97/197) and 96.4% (80/83) of patients with positive SPT (kappa = 0.435) and ASPP (kappa = 0.963), the positive finding and the VF segments were consistently colocalized.

Conclusions: The positive finding of RP or ASPP is useful in determining the spinal range for imaging tests, while an MRI scan covering the whole thoracic and lumbar spine is necessary in VF-suspected patients with P-RBP or positive SPT, indicating that caution is necessary when using symptoms or physical examination findings to localize VFs.

Keywords: Clinical sign; Diagnosis; Osteoporosis; Physical examination; Symptom; Vertebral fracture

Links

DOI: 10.1007/s00198-020-05434-9

PubMed: 32346773

WoS: 000529480200001

History

Received: 2020-01-30

Accepted: 2020-04-22

Online: 2020-04-28

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