Multivariate Risk Factor Analysis and Clinical Prediction Model Construction of Intercostal Neuralgia Following Single-Segment Osteoporotic Thoracic Vertebral Compression Fractures

Objective: To explore the multiple risk factors for intercostal neuralgia after osteoporotic thoracic vertebral compression fractures (OVCF), and to construct a clinical prediction model. Methods: The clinical data of 280 patients with single-segment thoracic OVCF admitted to our orthopedic department from January 2022 to December 2025 were retrospectively collected. Patients were categorized into neuropathic pain (NP) and non-neuropathic pain (non-NP) groups based on the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scale, with a score of ≥12 defining the primary outcome of intercostal neuralgia as neuropathic pain. Demographic data, fracture-related parameters, bone density, bone metabolism markers, and psychological status (Hospital Anxiety and Depression Scale, HADS) were collected. Univariate and multivariate Logistic regression analyses were used to screen independent risk factors, and the discrimination of the prediction model (area under the ROC curve, AUC) was evaluated. The model's performance was internally validated using the Bootstrap method. Results: Among the 280 patients, the incidence of neuropathic pain was 21.8% (61/280). Multivariate analysis identified six independent risk factors: middle thoracic fracture (T5-T8, OR=4.603), thoracolumbar fascia injury (TLFI, OR=4.883), injured vertebral width ratio (per 0.1 increase, OR=3.973), decreased bone mineral density T-score (per 1-unit decrease, OR=2.685), intravertebral vacuum cleft (IVC, OR=2.764), and depressive state (HADS≥8, OR=2.586). The prediction model showed good calibration (Hosmer-Lemeshow P=0.412) and discrimination (AUC=0.843, 95% CI: 0.789-0.897), with sensitivity 80.3%, specificity 76.7%, and negative predictive value 93.2%. Bootstrap internal validation yielded an optimism-corrected AUC of 0.831. Conclusion: Post-fracture intercostal neuralgia in osteoporotic thoracic vertebrae is multifactorial. Middle thoracic vertebra fractures, injury of the thoracolumbar fascia, increased ratio of injured vertebra width, decreased bone density, intravertebral vacuum fissure, and depressive state are independent risk factors. However, external validation in prospective multicenter studies is required before routine clinical implementation.