Ann Rehabil Med.  2013 Apr;37(2):191-201. 10.5535/arm.2013.37.2.191.

Effect of Medial Branch Block in Chronic Facet Joint Pain for Osteoporotic Compression Fracture: One Year Retrospective Study

• Park KD
• Jee H
• Nam HS
• Cho SK
• Kim HS
• Park Y
• Lim OK

• KMID: 2165770
• DOI: http://doi.org/10.5535/arm.2013.37.2.191

Abstract

OBJECTIVE
To evaluate the outcomes of medial branch block in facet joint pain for osteoporotic compression fracture and utilize multiple regression, the relationship between their impact on treatment outcome and other factor, such as the radiologic finding, clinical parameters was analyze.
METHODS
Fifty-three patients with axial back pain from osteoporotic compression fracture were enrolled. The clinical outcomes were measured by Verbal Numeric Rating Scale (VNS) and Oswestry Disability Index (ODI) before treatment, 2 weeks, 3 months, and 12 months after the medial branch block. Radiographic analysis included measurement of overall sagittal alignment, collapsed vertebral height, and vertebral kyphotic angle. After 12 months, patients' satisfaction was classified to five categories: excellent, good, fair, poor or fail. Statistical analysis of both radiographic and clinical parameters along with treatment outcome was performed to determine any significant correlations between the two.
RESULTS
VNS and ODI was improved 2 weeks after the injection and continued to improve until 12 months. Significant improvement with significant pain relief (>40%), functional improvement (>20%), and the patients rated their satisfaction level as "excellent" or "good" at 12 months after the first injection were observed in 78.9%. The radiographic and clinical parameters were not significantly correlated with treatment outcome.
CONCLUSION
Our retrospective study demonstrated that the medial branch block provided significant pain relief and functional recovery to the patients with osteoporotic spinal compression fractures complaining of continuous facet joint pain after vertebroplasty or conservative treatment. A placebo-controlled prospective randomized double-blind study should be conducted in the future to evaluate the treatment effects.

Keyword

Compression fractures; Osteoporotic fractures; Spinal injections

MeSH Terms

Back Pain
Double-Blind Method
Fractures, Compression
Humans
Injections, Spinal
Osteoporotic Fractures
Retrospective Studies
Treatment Outcome
Vertebroplasty
Zygapophyseal Joint

Figure

• 

  Fig. 1 T11, T12 medial branch block in patient with L1 compression fracture (vertebroplasty state). The T12-L1 joint is the medial branch of the T11 and T12 dorsal ramus. Anteroposterior radiography of contrast medium injected onto the target point for T11 and T12 medial branch blocks. The needle tip point to the contrast medium at the site for T11 and T12 medial branch blocks on the T12 and L1 superior articular processes. P, pedicle.

• 

  Fig. 2 The sagittal kyphotic angle of local segment was obtained by measuring the acute angle between the upper vertebral upper margin and lower vertebral lower margin of the collapsed vertebral body. β, measurement of the local kyphosis.

Reference

1. Bernstein J, Lane JM. Rothman RH, Siemone FA, editors. Metabolic disorders of the spine. The spine. 1992. 3rd ed. Philadelphia: WB Saunders;p. 1393–1394.

2. Rapado A. General management of vertebral fractures. Bone. 1996; 18(3 Suppl):191S–196S. PMID: 8777087.

3. Watts NB, Harris ST, Genant HK. Treatment of painful osteoporotic vertebral fractures with percutaneous vertebroplasty or kyphoplasty. Osteoporos Int. 2001; 12:429–437. PMID: 11446557.

4. Garfin SR, Yuan HA, Reiley MA. New technologies in spine: kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures. Spine (Phila Pa 1976). 2001; 26:1511–1515. PMID: 11462078.

5. Mitra R, Do H, Alamin T, Cheng I. Facet pain in thoracic compression fractures. Pain Med. 2010; 11:1674–1677. PMID: 21029349.

6. Georgy BA. Interventional techniques in managing persistent pain after vertebral augmentation procedures: a retrospective evaluation. Pain Physician. 2007; 10:673–676. PMID: 17876364.

7. Bogduk N. Evidence-informed management of chronic low back pain with facet injections and radiofrequency neurotomy. Spine J. 2008; 8:56–64. PMID: 18164454.

8. Bogduk N. Practice guidelines for spinal diagnostic and treatment procedures. 2004. 1st ed. San Francisco: International Spinal Intervention Society;p. 47–65.

9. Bogduk N, Wilson AS, Tynan W. The human lumbar dorsal rami. J Anat. 1982; 134(Pt 2):383–397. PMID: 7076562.

10. Bogduk N. The innervation of the lumbar spine. Spine (Phila Pa 1976). 1983; 8:286–293. PMID: 6226119.

11. Boswell MV, Shah RV, Everett CR, Sehgal N, McKenzie Brown AM, Abdi S, et al. Interventional techniques in the management of chronic spinal pain: evidence-based practice guidelines. Pain Physician. 2005; 8:1–47. PMID: 16850041.

12. Manchikanti L, Staats PS, Singh V, Schultz DM, Vilims BD, Jasper JF, et al. Evidence-based practice guidelines for interventional techniques in the management of chronic spinal pain. Pain Physician. 2003; 6:3–81. PMID: 16878163.

13. Manchikanti L, Manchikanti KN, Manchukonda R, Pampati V, Cash KA. Evaluation of therapeutic thoracic medial branch block effectiveness in chronic thoracic pain: a prospective outcome study with minimum 1-year follow up. Pain Physician. 2006; 9:97–105. PMID: 16703969.

14. Kim KT, Lee SH, Suk KS, Lee JH, Im YS, Seo EM. Loss of sagittal balance and clinical outcomes following corrective osteotomy for lumbar degenerative kyphosis. J Korean Orthop Assoc. 2009; 44:83–92.

15. Fairbank JC, Couper J, Davies JB, O'Brien JP. The Oswestry low back pain disability questionnaire. Physiotherapy. 1980; 66:271–273. PMID: 6450426.

16. Lee IS, Kim SH, Lee JW, Hong SH, Choi JY, Kang HS, et al. Comparison of the temporary diagnostic relief of transforaminal epidural steroid injection approaches: conventional versus posterolateral technique. AJNR Am J Neuroradiol. 2007; 28:204–208. PMID: 17296980.

17. Ng L, Chaudhary N, Sell P. The efficacy of corticosteroids in periradicular infiltration for chronic radicular pain: a randomized, double-blind, controlled trial. Spine (Phila Pa 1976). 2005; 30:857–862. PMID: 15834326.

18. Campbell WI, Kendrick RW. Pre-emptive analgesia using local anaesthesia: a study in bilaterally symmetrical surgery. Br J Anaesth. 1997; 79:657–659. PMID: 9422907.

19. Nam HS, Park YB. Effects of transforaminal injection for degenerative lumbar scoliosis combined with spinal stenosis. Ann Rehabil Med. 2011; 35:514–523. PMID: 22506167.

20. Ledlie JT, Renfro M. Balloon kyphoplasty: one-year outcomes in vertebral body height restoration, chronic pain, and activity levels. J Neurosurg. 2003; 98(1 Suppl):36–42. PMID: 12546386.

21. Beaman DN, Graziano GP, Glover RA, Wojtys EM, Chang V. Substance P innervation of lumbar spine facet joints. Spine (Phila Pa 1976). 1993; 18:1044–1049. PMID: 7690159.

22. Kim TK, Kim KH, Kim CH, Shin SW, Kwon JY, Kim HK, et al. Percutaneous vertebroplasty and facet joint block. J Korean Med Sci. 2005; 20:1023–1028. PMID: 16361816.

23. Manchikanti L, Singh V, Falco FJ, Cash KA, Pampati V. Lumbar facet joint nerve blocks in managing chronic facet joint pain: one-year follow-up of a randomized, double-blind controlled trial: Clinical Trial NCT00355914. Pain Physician. 2008; 11:121–132. PMID: 18354721.

24. Lee HM, Weinstein JN, Meller ST, Hayashi N, Spratt KF, Gebhart GF. The role of steroids and their effects on phospholipase A2: an animal model of radiculopathy. Spine (Phila Pa 1976). 1998; 23:1191–1196. PMID: 9636970.

25. Johansson A, Hao J, Sjolund B. Local corticosteroid application blocks transmission in normal nociceptive C-fibres. Acta Anaesthesiol Scand. 1990; 34:335–338. PMID: 2167604.

26. Arner S, Lindblom U, Meyerson BA, Molander C. Prolonged relief of neuralgia after regional anesthetic blocks: a call for further experimental and systematic clinical studies. Pain. 1990; 43:287–297. PMID: 1705693.

27. Benzon HT. Epidural steroid injections for low back pain and lumbosacral radiculopathy. Pain. 1986; 24:277–295. PMID: 3008063.

28. Lavoie PA, Khazen T, Filion PR. Mechanisms of the inhibition of fast axonal transport by local anesthetics. Neuropharmacology. 1989; 28:175–181. PMID: 2469989.

29. Katz WA, Rothenberg R. Section 3: The nature of pain: pathophysiology. J Clin Rheumatol. 2005; 11(2 Suppl):S11–S15. PMID: 16357723.

30. Cassuto J, Sinclair R, Bonderovic M. Anti-inflammatory properties of local anesthetics and their present and potential clinical implications. Acta Anaesthesiol Scand. 2006; 50:265–282. PMID: 16480459.

31. Weinstein JN, Collalto P, Lehmann TR. Thoracolumbar "burst" fractures treated conservatively: a long-term follow-up. Spine (Phila Pa 1976). 1988; 13:33–38. PMID: 3381135.

32. Willen J, Lindahl S, Nordwall A. Unstable thoracolumbar fractures: a comparative clinical study of conservative treatment and Harrington instrumentation. Spine (Phila Pa 1976). 1985; 10:111–122. PMID: 4002035.

33. Reid DC, Hu R, Davis LA, Saboe LA. The nonoperative treatment of burst fractures of the thoracolumbar junction. J Trauma. 1988; 28:1188–1194. PMID: 3411642.

34. Day B, Kokan P. Compression fractures of the thoracic and lumbar spine from compensable injuries. Clin Orthop Relat Res. 1977; (124):173–176. PMID: 598072.

35. Aglietti P, Di Muria GV, Taylor TK, Ruff SJ, Marcucci M, Novembri A, et al. Conservative treatment of thoracic and lumbar vertebral fractures. Ital J Orthop Traumatol. 1983; 9(Suppl):83–105. PMID: 6679850.

36. Shin BJ, Kim SK, Lee BI, Kim YI, Rah SK, Choi CU. Posterior column injuries in thoracolumbar and lumbar burst fractures. J Korean Soc Spine Surg. 1997; 4:67–73.

37. Schwarzer AC, Aprill CN, Derby R, Fortin J, Kine G, Bogduk N. The false-positive rate of uncontrolled diagnostic blocks of the lumbar zygapophysial joints. Pain. 1994; 58:195–200. PMID: 7816487.