Introduction: The pain of acute compression fracture may be refractory to conservative treatment. Interventions such as vertebroplasty or transpedicle screw-fixation and fusion may be effective, but complications such as chemical leak, adjacent segment instability are common. Percutaneous dorsal root ganglion block is an alternative therapeutic option, in this study, we evaluated its efficacy and associated complications.
Methods: A retrospective review of 45 patients with lumbar compression fracture from 2013 to 2015 was performed. Patients treated with percutaneous transforaminal dorsal root ganglion block with xylocaine / triamcinolone, and complete image studies (dynamic lateral X-ray, bone mineral density, and MRI) were included, and those with failed back syndrome, ruptured disc, infection, cancer or dementia were excluded. Treatment response evaluated by SF-36 and NRS was collected, and an acceptable outcome defined as a NRS of 3 or less at different time points were analyzed.
Results: Of the 45 patients treated, bodily pain of the SF-36 was not significantly different, but a significant difference in physical component score was found in between baseline and post-treatment at 1 year. The changes in mean NRS score to the baseline at day-1 was -5.5 (95 % CI -4.9 ~ -6.2, p<0.001), one week -5.5 (95 % CI -4.9 to -6.2, p<0.001), one month -5.3 (95 % CI -4.6 to -6.0, p<0.001), and one year -5.4 (95 % CI -4.7 to -6.3, p<0.001) were all statistically significant. An acceptable outcome was achieved in 35%(15 out of 43) on day-1, 37% (16 out of 43) in 1 week, 40% (17 out of 43) in 1 month, and 44% (19 out of 43) in 1 year and no complications were found.
Conclusions: Percutaneous dorsal root ganglion block is an easy and safe option for immediately pain relief in lumbar osteoporotic compression fracture patients who failed conservative treatment.The continuous medication for osteoporosis was still demanded.
Patient Care: short hospital stay and immediate pain relief without invasive open surgery
Learning Objectives: By the conclusion of this session, participants should be able to 1)Knowing the pathophysiology of percutaneous dorsal root ganglion block .2)The mechanism of adjacent compression fracture
References: 1. Klazen, C. A. H. et al. Clinical course of pain in acute osteoporotic vertebral compression fractures. J. Vasc. Interv. Radiol. JVIR 21, 1405–1409 (2010).
2. Leblanc, A. D., Schneider, V. S., Evans, H. J., Engelbretson, D. A. & Krebs, J. M. Bone mineral loss and recovery after 17 weeks of bed rest. J. Bone Miner. Res. Off. J. Am. Soc. Bone Miner. Res. 5, 843–850 (1990).
3. Trout, A. T., Kallmes, D. F. & Kaufmann, T. J. New Fractures after Vertebroplasty: Adjacent Fractures Occur Significantly Sooner. Am. J. Neuroradiol. 27, 217–223 (2006).
4. Genant, H. K., Wu, C. Y., van Kuijk, C. & Nevitt, M. C. Vertebral fracture assessment using a semiquantitative technique. J. Bone Miner. Res. Off. J. Am. Soc. Bone Miner. Res. 8, 1137–1148 (1993).
5. Ware, J. E. & Sherbourne, C. D. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med. Care 30, 473–483 (1992).
6. Klazen, C. A. et al. Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial. The Lancet 376, 1085–1092 (2010).
7. Al-Nakshabandi, N. A. Percutaneous vertebroplasty complications. Ann. Saudi Med. 31, 294–297 (2011).
8. Blasco, J. et al. Effect of vertebroplasty on pain relief, quality of life, and the incidence of new vertebral fractures: a 12-month randomized follow-up, controlled trial. J. Bone Miner. Res. Off. J. Am. Soc. Bone Miner. Res. 27, 1159–1166 (2012).
9. Zhang, Z., Fan, J., Ding, Q., Wu, M. & Yin, G. Risk factors for new osteoporotic vertebral compression fractures after vertebroplasty: a systematic review and meta-analysis. Clin. Spine Surg. 26, E150–E157 (2013).
10. al, Z. J., et. The long-term incidence of subsequent vertebral body fracture after vertebral augmentation therapy: a systemic review and meta-analysis. - PubMed - NCBI. Available at: https://www.ncbi.nlm.nih.gov/pubmed/22828697. (Accessed: 13th January 2017)
11. Bartynski, W. S. Clinical, Anatomic, and Imaging Correlation in Spine-Related Pain: The Essential Elements. Tech. Vasc. Interv. Radiol. 12, 2–10 (2009).
12. Woolf, C. J., American College of Physicians & American Physiological Society. Pain: moving from symptom control toward mechanism-specific pharmacologic management. Ann. Intern. Med. 140, 441–451 (2004).
13. Kelly, D. J., Ahmad, M. & Brull, S. J. Preemptive analgesia I: physiological pathways and pharmacological modalities. Can. J. Anaesth. 48, 1000–1010 (2001).
14. Stucky, C. L., Gold, M. S. & Zhang, X. Mechanisms of pain. Proc. Natl. Acad. Sci. 98, 11845–11846 (2001).
15. Kidd, B. L. & Urban, L. A. Mechanisms of inflammatory pain. Br. J. Anaesth. 87, 3–11 (2001).
16. Woolf, C. J. & Salter, M. W. Neuronal plasticity: increasing the gain in pain. Science 288, 1765–1769 (2000).
17. Onofrio, B. M. & Campa, H. K. Evaluation of rhizotomy. Review of 12 years’ experience. J. Neurosurg. 36, 751–755 (1972).