The Pain of Vertebral Compression Fractures Can Arise in the Posterior Elements

被引:29
作者
Bogduk, Nikolai [1 ]
MacVicar, John [2 ]
Borowczyk, James [3 ]
机构
[1] Royal Newcastle Ctr, Newcastle Bone & Joint Inst, Newcastle, NSW 2300, Australia
[2] St Georges Med Ctr, So Rehabil Inst, Christchurch, New Zealand
[3] Univ Otago, Christchurch Sch Med, Dept Orthopaed & Musculoskeletal Med, Christchurch, New Zealand
关键词
Osteoporosis; Compression Fracture; pain; Diagnostic Block; Medial Branch; RANDOMIZED-TRIAL; VERTEBROPLASTY;
D O I
10.1111/j.1526-4637.2010.00963.x
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Objectives. To describe and test a model to explain the biomechanical basis for persistent pain after compression fractures of the vertebral body. Methods. The biomechanics model was derived axiomatically from a consideration of the anatomy of vertebral column when affected by compression fractures. Proof of principle was provided by performing controlled diagnostic blocks in six patients. Results. The biomechanics model shows that the posterior elements of the vertebral column must subluxate cephalad or caudad in response to deformity of a vertebral body. The model implies that pain may arise from the posterior elements, and predicts that anesthetizing the posterior elements should relieve the pain of compression fractures. Six cases are described in which controlled medial branch blocks relieved the pain of compression fractures of thoracic or lumbar vertebral bodies. Conclusions. In some patients with vertebral compression fractures, the pain may arise from posterior elements and not the fracture itself. This phenomenon has implications for the interpretation of the outcomes of vertebroplasty in both the active and control arms of sham-controlled studies.
引用
收藏
页码:1666 / 1673
页数:8
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