S Kamalian1, R Bordia, A O Ortiz. 1. Department of Radiology, Winthrop University Hospital, Mineola, New York 11501, USA. shahmirkamalian@gmail.com
Abstract
BACKGROUND AND PURPOSE: Vertebral augmentation is an established treatment for painful osteoporotic vertebral fractures of the spine. Nevertheless, patients may continue to have significant back pain afterward. The purpose of this study was to assess the source of persistent or recurrent back pain following vertebral augmentation. MATERIALS AND METHODS: Our institutional review board approved this study. We evaluated 124 consecutive patients who underwent vertebral augmentation for painful osteoporotic vertebral fractures. All patients were evaluated after 3 weeks, 3 months, and 1 year following their procedure. Patients with any type of back pain after their procedure were examined under fluoroscopy. RESULTS: Thirty-four of 124 (27%) patients were men, and 90/124 (73%) were women. Persistent or recurrent back pain, not due to a new fracture or a failed procedure, was present in 29/124 (23%) patients. The source of pain was most often attributed to the sacroiliac and/or lumbar facet joints (25/29 or 86%). Seventeen of 29 (59%) patients experienced immediate relief after facet joint injection of a mixture of steroid and local anesthetic agents. The remaining 12 (41%) had relief after additional injections. Ten (34%) patients ultimately required radio-frequency neurolysis for long-term relief. CONCLUSIONS: Back pain after vertebral augmentation may not be due to a failed procedure but rather to an old or a new pain generator, such as an irritated sacroiliac or lumbar facet joint. This is of importance not only for further pain management of these patients but also for designing trials to compare the efficacy of vertebral augmentation to other treatments.
BACKGROUND AND PURPOSE: Vertebral augmentation is an established treatment for painful osteoporotic vertebral fractures of the spine. Nevertheless, patients may continue to have significant back pain afterward. The purpose of this study was to assess the source of persistent or recurrent back pain following vertebral augmentation. MATERIALS AND METHODS: Our institutional review board approved this study. We evaluated 124 consecutive patients who underwent vertebral augmentation for painful osteoporotic vertebral fractures. All patients were evaluated after 3 weeks, 3 months, and 1 year following their procedure. Patients with any type of back pain after their procedure were examined under fluoroscopy. RESULTS: Thirty-four of 124 (27%) patients were men, and 90/124 (73%) were women. Persistent or recurrent back pain, not due to a new fracture or a failed procedure, was present in 29/124 (23%) patients. The source of pain was most often attributed to the sacroiliac and/or lumbar facet joints (25/29 or 86%). Seventeen of 29 (59%) patients experienced immediate relief after facet joint injection of a mixture of steroid and local anesthetic agents. The remaining 12 (41%) had relief after additional injections. Ten (34%) patients ultimately required radio-frequency neurolysis for long-term relief. CONCLUSIONS:Back pain after vertebral augmentation may not be due to a failed procedure but rather to an old or a new pain generator, such as an irritated sacroiliac or lumbar facet joint. This is of importance not only for further pain management of these patients but also for designing trials to compare the efficacy of vertebral augmentation to other treatments.
Authors: M H J Voormolen; W P T M Mali; P N M Lohle; H Fransen; L E H Lampmann; Y van der Graaf; J R Juttmann; X Jansssens; H J J Verhaar Journal: AJNR Am J Neuroradiol Date: 2007-03 Impact factor: 3.825
Authors: Laxmaiah Manchikanti; Vijay Singh; Frank J E Falco; Kimberly A Cash; Vidyasagar Pampati Journal: Int J Med Sci Date: 2010-05-28 Impact factor: 3.738
Authors: Rachelle Buchbinder; Richard H Osborne; Peter R Ebeling; John D Wark; Peter Mitchell; Chris Wriedt; Stephen Graves; Margaret P Staples; Bridie Murphy Journal: N Engl J Med Date: 2009-08-06 Impact factor: 91.245
Authors: J Bart Staal; Rob A de Bie; Henrica C W de Vet; Jan Hildebrandt; Patty Nelemans Journal: Spine (Phila Pa 1976) Date: 2009-01-01 Impact factor: 3.468
Authors: V T Lehman; C P Wood; C H Hunt; R E Carter; J B Allred; F E Diehn; J M Morris; J T Wald; K R Thielen Journal: AJNR Am J Neuroradiol Date: 2013-02-28 Impact factor: 3.825