INTRODUCTION: Patients with osteoporotic vertebral fractures (OVFs) demonstrate a variety of pain distribution and pattern. The pain often spreads over the fracture site and radiates to the remote regions. We analyzed modes of pain presentation in OVFs, and differences between acute fresh fractures and chronic vertebral non‐unions.
METHODS: We investigated initial symptoms at the first visit in 66 patients with a single level fresh OVF, and preoperative symptoms in 43 patients with a single level chronic non‐union treated by vertebroplasty. The association between the pain drawing and fracture level was also analysed.
RESULTS: The most painful activity of daily living was lying down on and getting up from the bed in 98.5% of fresh fracture and in 44.2% of non‐union groups, followed by continuous standing or sitting in 1.5% of fresh fracture and 36.5% of non‐union groups. In both groups, the pain was likely to be presented more caudally and laterally from the fracture site. Thoracolumbar (T11‐L1) fracture in both groups caused pain in mid‐lower lumbar and buttock regions, and sometimes in the side and anterior abdominal wall. In the lumbar level(L2‐5) fractures, low back and buttock pain was most common in both groups. However thigh pain was also noted in 27% of the fresh fracture and 33% of the non‐union groups.
DISCUSSION: Thoracolumbar fractures often mimicked the pain distribution of the lower lumbar degenerative disorders. Conversely, complains of lower lumbar and buttock pain in elderly patients can not exclude the possibility of thoracolumbar OVFs. Lumbar fractures sometimes mimicked radicular pain in the thigh. In the fresh fractures, dynamic fracture mobility elicited by lying down on and getting up from the bed was the primary pain generator. In the severely collapsed vertebral non‐union, the primary pain mechanism was not only dynamic fracture mobility but also the local angular kyphosis, which might cause back muscle fatigue pain.