Percutaneous kyphoplasty for the treatment of distal lumbosacral pain caused by osteoporotic thoracolumbar vertebral fracture.

Background Kyphoplasty has been demonstrated to be minimally invasive and effective in treating osteoporotic vertebral fracture patients with back pain over the level of the fractured vertebrae. Rare studies have reported on thoracolumbar vertebral fracture patients presenting with distal lumbosacral pain (DLP). Whether kyphoplasty had a favorable therapeutic benefit for these patients remains unclear. Purpose To evaluate the therapeutic efficacy of kyphoplasty in treating osteoporotic thoracolumbar vertebral fracture (OTVF) patients with DLP and assess the clinical significance of focal tenderness to palpation in these patients. Material and Methods Thirty-two OTVF patients who only complained of DLP were treated by kyphoplasty. The vertebral heights, local kyphotic angle, Visual Analogue Scale (VAS), and Oswestry Disability Index (ODI) scores were assessed preoperatively, one day after surgery, and at last follow-up. All patients were evaluated regarding their degree of satisfaction with kyphoplasty. In addition, we compared the therapeutic efficacy of kyphoplasty in patients with and without focal tenderness to palpation. Results All patients successfully underwent kyphoplasty without complications. The vertebral heights, local kyphotic angles, VAS, and ODI scores were all significantly improved after kyphoplasty and maintained at last follow-up in our patients ( P < 0.001). At last follow-up, all patients expressed satisfaction with kyphoplasty. No significant differences in these parameters were detected between patients with and without focal tenderness. Conclusion The possibility of thoracolumbar vertebral fractures in elderly patients complaining of DLP should not be neglected. Kyphoplasty presents a superior benefit in treating OTVF patients with DLP. The absence of focal tenderness does not influence the clinical efficacy in these patients.

Local Anesthetic and Steroid Injection to Relieve the Distal Lumbosacral Pain in Osteoporotic Vertebral Compression Fractures of Patients Treated with Kyphoplasty.

BACKGROUND: Percutaneous kyphoplasty (PKP) is widely used in osteoporotic vertebral compression fractures (OVCF). But in some patients, distal lumbosacral pain (DLP) persists even after treatment and affects their quality of life. OBJECTIVE: To investigate the effectiveness of local anesthetic and steroid injection in improving DLP after PKP. STUDY DESIGN: A prospective, randomized, and controlled clinical trial. SETTING: The study was carried out in a university hospital. METHODS: A total of 150 patients were included in this study and randomly divided into 2 groups of 75 patients each. Patients in the control group (PKP) underwent PKP, and those in the observation group (PKP + LAI) received an injection of lidocaine + triamcinolone acetonide suspensions during the surgery. The visual analog scale (VAS) of the fracture site, Oswestry disability index (ODI), and the rate of patients with lower back pain were compared between the 2 groups at 1 day, 3 days, 1 week, 1 month, and 3 months after the surgery. RESULTS: One hundred thirty-nine patients completed the entire postoperative follow-up schedule, with 70 patients in the PKP group and 69 cases in the PKP + LAI group. The VAS and ODI in the PKP + LAI group were significantly lower than those in the PKP group 1 day, 3 days, 1 week, and 1 month after the surgery; there was no significant difference  3 months after the operation. The rate of patients with lower back pain in the PKP + LAI group 1 day, 3 days, and 1 week after the operation was significantly lower than that in the control group; there was no significant difference 1 month and 3 months after the operation. LIMITATIONS: The number of cases was small, and the follow-up time was short. CONCLUSION: Local anesthetic and steroid injection improved the short-term clinical outcome of PKP for OVCF, which will enhance the confidence of patients in performing out-of-bed activities and functional exercises early after the operation.

Percutaneous kyphoplasty for a patient of thoracolumbar osteoporotic vertebral compression fractures with distal lumbosacral pain: a case report.

When patients combined thoracolumbar osteoporotic vertebral compression fracture (OVCF) with lumbar degenerative disease, whose main clinical manifestations are distal lumbosacral pain (DLP), the therapeutic schedule should be made cautiously. We reported an 80-year-old female presented with long-term lumbosacral pain accused of lumbar disc herniation. Percutaneous kyphoplasty (PKP) had been received because of OVCF at L1 vertebral body. Twenty days ago, the elderly felt the DLP was aggravated with no obvious reason. Magnetic resonance imaging (MRI) showed the fresh compression fracture of L2 vertebral body, but the palpation found absence of focal tenderness. Then, we chose to perform PKP at L2 vertebral body, and the patient felt substantial pain relief of lumbosacral area after operation. This case showed that patient manifested as DLP that combined thoracolumbar OVCF with lumbar degenerative disease, PKP has a significant relieving effect on lumbosacral pain.