Interventional Spine

Shahmir, Kamalian, M.D.
Ritu, Bordia, MD, Non ASSR Member
Orlando, A, Ortiz, M.D., Non ASSR Member

Paper/Mentor

Purpose

Vertebral augmentation is an established treatment for painful vertebral compression fractures of the spinal column. Nevertheless, patients may continue to have significant back pain after the procedure. The purpose of our study was to assess the source of persistent of recurrent thoracic or lower back pain following a vertebral augmentation procedure.

Methods & Materials

We evaluated 124 consecutive patients who underwent vertebral augmentation for painful osteoporotic vertebral compression fractures at our institution retrospectively from July 2007 to July 2009. All patients were routinely evaluated and examined after the procedure at 3 weeks, 3 months and up to one year. Patients with any type of back pain after the procedure were examined under fluoroscopy in order to assess the postoperative site, assess for the presence of a new vertebral compression fracture or
identify the site of pain along the spinal axis.

Results

124 patients underwent vertebroplasty or kyphoplasty. 29 of the 124 (23%) patients had persistent or recurrent back pain which was not due to a new fracture or a failed procedure. The source of pain was attributed to the sacroiliac joints in 20/29 (69%) cases, to lumbar facet joint in 2/29 (<1%) cases, to thoracic fact joint in 1/29 (<1%) cases, sacroiliac and lumbar facet joints 3/29 (1%) cases, sacroiliac and lumbar facet joints in 1/29 (<1%) cases, lumbar and thoracic facet joints 1/29 (<1%) cases. One of the cases (<1%) had lumbar and thoracic facet joint disease as well as cervical radiculopathy. 25/29 (86%)of patients had pain relief after sacroiliac, lumbar or thoracic facet joint injection of steroid and local anesthetic agents. The remaining 4 patients (14%) had pain relief after additional facet joint injections.

Conclusion

Back pain after vertebral augmentation may be not due to a failed or limited procedure but rather to an old or a new pain generator such as an irritated sacroiliac or thoracic or lumbar facet joint. This is of importance in further management of patients or for designing trials to compare the efficacy of vertebral augmentation to other treatments.

References/Financial Disclosures

Financial Disclosures:

Shahmir Kamalian:
None.

Ritu Bordia:
None

Orlando A. Ortiz:
1. consultant – Spinewave, Inc.
2. Speakers bureau – Medtronic Spine