Sarcopenia is an independent predictor of residual back pain after percutaneous vertebroplasty. A 1:2 matched case-control study

To investigate whether sarcopenia is associated with residual back pain (RBP) after percutaneous vertebroplasty (PVP) in patients with osteoporotic vertebral compression fractures (OVCF). This 1:2 matched case-control study included 210 patients with OVCF, comprising 70 patients with RBP (defined as VAS ≥ 4 at 1 month postoperatively) and 140 matched non-RBP controls by age and sex. Preoperative SMI was derived from L3 skeletal muscle area measured on abdominal CT. Sarcopenia was defined based on the concurrent presence of low SMI and reduced handgrip strength (HS) according to established diagnostic criteria. Multivariable logistic regression with multiple models was conducted to isolate the independent effect of sarcopenia on postoperative RBP risk, while adjusting for relevant covariates including cement distribution. The RBP group had significantly lower SMI (31.66 vs. 36.32 cm²/m², P < 0.001), lower HS (21.17 vs. 22.51 kg, P = 0.017), and higher prevalence of sarcopenia (42.9% vs. 13.6%, P < 0.001) compared with the non-RBP group. Cement distribution scores were also lower in the RBP group (9.6 vs. 9.9, P = 0.009). ROC analysis demonstrated that SMI consistently exhibited superior diagnostic accuracy compared with HS, achieving the highest AUC (0.739) among women, with an optimal cutoff value of ≤ 31.3 cm²/m². Multivariable analysis confirmed that both sarcopenia (OR = 5.856) and SMI (OR = 0.845) were independently associated with RBP (both P < 0.001) in any models, whereas HS was not significant after adjusted analysis. Sarcopenia is the primary independent predictor of RBP after PVP, while cement distribution serves a secondary protective role.