Ohtori Seiji, Yamashita Masaomi, Inoue Gen, Yamauchi Kazuyo, Suzuki Munetaka, Orita Sumihisa, Eguchi Yawara, Ochiai Nobuyasu, Kishida Shunji, Takaso Masashi, Takahashi Kazuhisa
Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan.
J Pain. 2009 Aug;10(8):870-5. doi: 10.1016/j.jpain.2009.03.002.
Elderly patients with osteoporosis sometimes experience lumbar vertebral fracture and may feel diffuse nonlocalized pain in the back, the lateral portion of the trunk, and the area surrounding the iliac crest. The pattern of sensory innervation of vertebral bodies remains unclear. Some sensory nerves from the L2 and L5 vertebral bodies may enter the paravertebral sympathetic trunks and reach the L2 dorsal root ganglion. Our randomized controlled study was to clarify the effect of L2 spinal nerve block on low back pain originating from acute osteoporotic lumbar vertebral fracture. Patients with low back pain originating from acute L3 or L4 osteoporotic vertebral fractures received a spinal nerve root block (L2 block group, n = 30) or subcutaneous injection (control, n = 30). Both groups received 1.5 mL of 1% lidocaine. The visual analog scale score, Roland Morris Disability Questionnaire, and Short Form questionnaire were examined before and after treatment. In both groups, spinal nerve blocks were significantly effective in alleviating low back pain (P < .05). One hour, 1 week, and 2 weeks after treatment, the visual analog scale score improved more in the L2 block group than in the control group (P < .05). From 1 month to 4 months after treatment, there were no significant differences in the pain scores between groups (P > .05). We conclude that L2 spinal nerve block for acute L3 or L4 osteoporotic vertebral body fracture was effective for 2 weeks, but it had no long-term effects on pain and social function.
L2 spinal nerve block treatment for L3 or L4 osteoporotic vertebral body fracture was effective. This results suggest that the L2 dorsal root ganglion may innervate the L3 and L4 vertebral bodies in humans. L2 spinal nerve block for lumbar osteoporotic vertebral fracture may be a useful strategy to treat acute low back pain.
患有骨质疏松症的老年患者有时会发生腰椎骨折，并可能在背部、躯干外侧和髂嵴周围区域感到弥漫性的非局限性疼痛。椎体的感觉神经支配模式尚不清楚。来自L2和L5椎体的一些感觉神经可能进入椎旁交感干并到达L2背根神经节。我们的随机对照研究旨在阐明L2脊神经阻滞对急性骨质疏松性腰椎骨折引起的腰痛的影响。患有急性L3或L4骨质疏松性椎体骨折引起的腰痛的患者接受了脊神经根阻滞（L2阻滞组，n = 30）或皮下注射（对照组，n = 30）。两组均接受1.5 mL 1%的利多卡因。在治疗前后检查视觉模拟量表评分、罗兰·莫里斯残疾问卷和简短问卷。在两组中，脊神经阻滞在缓解腰痛方面均有显著效果（P < 0.05）。治疗后1小时、1周和2周，L2阻滞组的视觉模拟量表评分比对照组改善得更多（P < 0.05）。治疗后1个月至4个月，两组之间的疼痛评分无显著差异（P > 0.05）。我们得出结论，L2脊神经阻滞治疗急性L3或L4骨质疏松性椎体骨折在2周内有效，但对疼痛和社会功能没有长期影响。
L2脊神经阻滞治疗L3或L4骨质疏松性椎体骨折是有效的。这些结果表明，L2背根神经节可能在人类中支配L3和L4椎体。L2脊神经阻滞治疗腰椎骨质疏松性骨折可能是治疗急性腰痛的一种有用策略。
