Introduction: Osteoporotic vertebral compression fracture (OVCF) in the elderly is a major public health concern. This retrospective case-control study aimed to determine the difference in interobserver reliability between radiography, magnetic resonance imaging (MRI), and computed tomography (CT), respectively, and whether CT radiological findings can predict prolonged back pain at 2 weeks after OVCFs.

Methods: Patients were divided into the prolonged back pain group or the recovered back pain group depending on the numerical rating scale at 2 weeks after admission. Radiography, MRI, and CT images were classified on the basis of conventions described by previous classifications. Interobserver reliability was calculated on images rated by two board-certified spine surgeons. Multivariate logistic regression models were used to evaluate whether the presence or absence of anterior wall injury, endplate deficit, posterior wall injury, lateral wall injury, or intervertebral disc deficit on CT was predictive of prolonged back pain.

Results: Of the 130 patients, 89 cases (68.5%) involved prolonged back pain at 2 weeks after admission. Neither average age (79.8 vs. 80.1 years, respectively) nor duration to initial consultation (9.4 vs. 6.4 days, respectively) differed significantly between the prolonged and recovered back pain groups. Interobserver reliability was 0.51, 0.77 (0.67-0.86), and 0.82 (0.72-0.92) for radiography, MRI, and CT, respectively. After adjusting for confounding factors such as age, sex, duration to initial consultation, and extent of OVCF, the multivariate analysis showed that the presence of endplate deficit and posterior wall injury was a significant predictive factor for prolonged back pain (odds ratio [OR] 8.5, area under the curve (AUC); 0.79 and OR 2.5, AUC 0.72), respectively.

Conclusions: Good reliability assessments of CT-based evaluations were noted. After a detailed novel CT evaluation at initial presentation, the presence of an endplate deficit and posterior wall injury was the significant risk factor for prolonged back pain at 2 weeks after an OVCF.