Wei-Chao Huang1, Martin Hsiu-Chu Lin1, Ming-Hsueh Lee1,2, Kuo-Tai Chen1, Chun-Yu Cheng1, Chun-Hsien Lin1, Wei Hsun Yang1, Ting-Chung Wang1, Jen-Tsung Yang3,4. 1. Department of Neurosurgery, Chang Gung Memorial Hospital, Chia-Yi Branch, Sec 6, Chia Pu West Rd., Pu Tz City, Chia-Yi, Taiwan, 61636. 2. Chang Gung University of Science and Technology, Chia-Yi, Taiwan. 3. Department of Neurosurgery, Chang Gung Memorial Hospital, Chia-Yi Branch, Sec 6, Chia Pu West Rd., Pu Tz City, Chia-Yi, Taiwan, 61636. jents716@ms32.hinet.net. 4. College of Medicine, Chang Gung University, Tao-Yuan, 33302, Taiwan. jents716@ms32.hinet.net.
Abstract
BACKGROUND: The pain of acute compression fracture in the lumbar spine may be refractory to conservative treatment, and surgery is not an optimal choice for the elderly or infirm individuals. Moreover, even vertebroplasty can cause many side effects such as chemical leak, adjacent segment instability, and residual pain. Percutaneous dorsal root ganglion block (PDRGB) possibly is an alternative therapeutic option. In this study, we evaluated the efficacy of pain relief and the rate of adjacent level compression fracture in patients with acute compression fracture of the lumbar spine. METHODS: We retrospectively reviewed 40 patients with lumbar compression fracture from 2013 to 2015. The patients were treated with navigation-assisted CT-guided PDRGB with steroid at the pathological level and at the adjacent level above and below. Therapeutic response was evaluated using the Numerical Rating Scale (NRS); and an optimal, acceptable, and unfavorable outcome were analyzed. RESULTS: Among the 40 patients treated, initial pain relief on the first day was dramatic, and the average NRS did not change significantly up to the first-year follow-up. The highest percentage of a good outcome, at 90% (37.5% with an optimal outcome, 52.5% with an acceptable outcome), was reported at 1 week postoperatively. The percentage of optimal outcomes increased even at the 1-year follow-up. No adjacent compression fracture was found in the group treated with PDRGB alone at the 1-year follow-up. CONCLUSIONS: PDRGB is a simple, safe, and minimally invasive procedure that showed immediate and prolonged improvement of pain in lumbar osteoporotic compression fracture patients who failed conservative treatment or had residual pain after vertebroplasty. However, continuous medication for osteoporosis was still required.
BACKGROUND: The pain of acute compression fracture in the lumbar spine may be refractory to conservative treatment, and surgery is not an optimal choice for the elderly or infirm individuals. Moreover, even vertebroplasty can cause many side effects such as chemical leak, adjacent segment instability, and residual pain. Percutaneous dorsal root ganglion block (PDRGB) possibly is an alternative therapeutic option. In this study, we evaluated the efficacy of pain relief and the rate of adjacent level compression fracture in patients with acute compression fracture of the lumbar spine. METHODS: We retrospectively reviewed 40 patients with lumbar compression fracture from 2013 to 2015. The patients were treated with navigation-assisted CT-guided PDRGB with steroid at the pathological level and at the adjacent level above and below. Therapeutic response was evaluated using the Numerical Rating Scale (NRS); and an optimal, acceptable, and unfavorable outcome were analyzed. RESULTS: Among the 40 patients treated, initial pain relief on the first day was dramatic, and the average NRS did not change significantly up to the first-year follow-up. The highest percentage of a good outcome, at 90% (37.5% with an optimal outcome, 52.5% with an acceptable outcome), was reported at 1 week postoperatively. The percentage of optimal outcomes increased even at the 1-year follow-up. No adjacent compression fracture was found in the group treated with PDRGB alone at the 1-year follow-up. CONCLUSIONS: PDRGB is a simple, safe, and minimally invasive procedure that showed immediate and prolonged improvement of pain in lumbar osteoporotic compression fracturepatients who failed conservative treatment or had residual pain after vertebroplasty. However, continuous medication for osteoporosis was still required.
Authors: Mark V Boswell; Andrea M Trescot; Sukdeb Datta; David M Schultz; Hans C Hansen; Salahadin Abdi; Nalini Sehgal; Rinoo V Shah; Vijay Singh; Ramsin M Benyamin; Vikram B Patel; Ricardo M Buenaventura; James D Colson; Harold J Cordner; Richard S Epter; Joseph F Jasper; Elmer E Dunbar; Sairam L Atluri; Richard C Bowman; Timothy R Deer; John R Swicegood; Peter S Staats; Howard S Smith; Allen W Burton; David S Kloth; James Giordano; Laxmaiah Manchikanti Journal: Pain Physician Date: 2007-01 Impact factor: 4.965
Authors: M S LeBoff; S L Greenspan; K L Insogna; E M Lewiecki; K G Saag; A J Singer; E S Siris Journal: Osteoporos Int Date: 2022-04-28 Impact factor: 5.071