Abstract
Background and Objectives: The current options for acute pain control of vertebral compression fracture include hard brace, vertebroplasty, early surgery, and analgesic injection. We hypothesize that the gray ramus communicans nerve block (GRNB) controls the acute pain experienced during vertebral compression fractures. This study assessed the time course of pain control after injection and evaluated the risk factors affecting pain control failure. Materials and methods: Sixty-three patients (24 male, 66.19 ± 15.17 y) with a thoracolumbar vertebral fracture at the T10-L5 spine, who presented to our hospital from November 2018 to October 2019, were included in this retrospective cohort study. GRNB was performed within 1 week of the trauma. The patients were followed up on days 3, 14, 30, 90, and 180 and assessed with the serial visual analog scale (VAS, resting and motion), Oswestry Low Back Disability (ODI) questionnaire, and Roland–Morris Disability Questionnaire (RDQ). The failure group was defined by the need for an additional block or cement injection after a single GRNB. The failure group’s risk factors, such as body mass index, initial thoracolumbar injury classification and severity score, Kummel’s disease, age, bone marrow density (BMD), and underlying disease, were analyzed. Results: The motion VAS score improved from preoperative to three months post-procedure, but the resting VAS was affected by the procedure for only three days. The quality of life index improved at postoperative six months. A lower BMD was the only risk that affected treatment failure in the logistic regression analysis (p = 0.0038). Conclusion: The effect of GRNB was maintained even at three months after trauma based on motion VAS results. The only risk factor identified for GRNB failure was lower BMD.
Highlights
As we have entered an aging society, osteoporotic vertebral fractures are on the rise, and the number of patients with traumatic vertebral fractures is increasing [1]
Spinal compression fracture is the most common complication, and a 12–40% prevalence of osteoporotic compression fractures has been reported among individuals >50 years [2,3,4]
We found spinal fracture patients admitted to the neurosurgery department between 1 November 2018 and 1 November 2019 through electronic medical record (EMR) system
Summary
As we have entered an aging society, osteoporotic vertebral fractures are on the rise, and the number of patients with traumatic vertebral fractures is increasing [1]. Spinal compression fracture is the most common complication, and a 12–40% prevalence of osteoporotic compression fractures has been reported among individuals >50 years [2,3,4]. Most vertebral fractures heal naturally over time, and the pain is relieved. Several papers have demonstrated that vertebroplasty or kyphoplasty effectively relieves pain in patients with osteoporotic vertebral fracture [6,7,8,9]. There has been no study on how long the effect of gray ramus nerve block was maintained and what patient characteristic impacts its duration. We designed this study to confirm that the GNRB effectively reduces pain in patients with vertebral body fractures and to analyze the cause of treatment failure in the ineffective group
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