Gluteal muscle atrophy linked to residual back pain after vertebral augmentation for OVCFStudy links smaller gluteal muscles to back pain after spinal fracture treatment

Frontiers in Medicine Published April 8, 2026 DOI ↗ Editorial oversight: Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

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Key Takeaway

Consider gluteal muscle morphology as a potential risk factor for residual pain after vertebral augmentation, but recognize evidence is retrospective.

A retrospective cohort study at two centers analyzed 428 patients with osteoporotic vertebral compression fractures who underwent percutaneous vertebral augmentation. The study aimed to identify risk factors for residual back pain following the procedure. No comparator group was reported in this observational analysis.

The overall incidence of residual back pain was 17.5%. Reduced relative cross-sectional area of the gluteus maximus was identified as a significant risk factor (p=0.012). Reduced relative cross-sectional area of the gluteus medius also emerged as a significant risk factor, though the exact p-value was not fully reported. No effect sizes or absolute numbers were provided for these associations.

Safety and tolerability data were not reported. The study developed a novel nomogram incorporating core muscle morphology for personalized residual back pain risk stratification. Key limitations include the retrospective design, lack of reported effect sizes, and absence of a comparator group. The single-study nature limits generalizability.

For practice, this study identifies a potential association between gluteal muscle morphology and residual pain outcomes after vertebral augmentation. The findings suggest core muscle assessment might eventually contribute to risk stratification, but the retrospective evidence requires prospective validation before influencing clinical decision-making. Clinicians should interpret these associations cautiously given the study design limitations.

This study looked at patients with osteoporosis who had a spinal fracture and then underwent a procedure called percutaneous vertebral augmentation (PVA). The procedure stabilizes the broken bone. Researchers wanted to understand why some patients still had back pain after this treatment.

The study included 428 patients from two medical centers. The researchers reviewed their medical records and MRI scans. They found that about 17.5% of patients had lingering back pain. A key finding was that patients with a smaller cross-sectional area in their gluteus maximus and gluteus medius muscles were more likely to have this residual pain.

This was a retrospective study, meaning it looked back at existing data. This type of study can identify associations but cannot prove that smaller muscles cause the pain. The study did not report on the size of this effect or on any safety issues. The results suggest that core muscle health might be a factor in recovery, but more research is needed to confirm this link and understand its importance.

What this means for you:

Smaller gluteal muscles were linked to more back pain after spinal fracture treatment in one study, but more research is needed.

Study Details

Study typeCohort

EvidenceLevel 3

PublishedApr 2026

View Original Abstract ↓

BackgroundResidual back pain (RBP) after percutaneous vertebral augmentation (PVA) for osteoporotic vertebral compression fractures (OVCF) remains a significant clinical challenge. Traditional prediction models focus primarily on bone mineral density and procedural factors. This study aimed to develop and validate a novel nomogram that incorporates the morphology of core muscles, notably the gluteal muscles, for personalized RBP risk stratification.MethodsIn this retrospective study, clinical data from 428 OVCF patients who underwent PVA at two centers were analyzed. Patients were randomly divided into training and validation cohorts (3:1 ratio). Variables included demographics, fracture characteristics, procedural details, and computed tomography-based measurements of the relative cross-sectional area (rCSA) of paravertebral (multifidus, erector spinae, psoas) and pelvic [gluteus maximus (Gmax), gluteus medius (Gmed)] muscles. Least absolute shrinkage and selection operator and multivariate logistic regression were used to select predictors and build a nomogram. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), calibration, and decision curve analysis.ResultsThe overall incidence of RBP was 17.5%. The final model identified eight independent predictors. Alongside established factors like greater fracture burden and lower cement volume, reduced rCSA of the Gmax and Gmed emerged as significant and strong risk factors (p = 0.012 and p

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