Risk factors and management of early pain non-response after vertebroplasty in osteoporotic vertebral compression fractures.

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.