Royal Newcastle Centre, Newcastle Bone and Joint Institute, Newcastle, New South Wales, Australia.
Pain Med. 2010 Nov;11(11):1666-73. doi: 10.1111/j.1526-4637.2010.00963.x.
To describe and test a model to explain the biomechanical basis for persistent pain after compression fractures of the vertebral body.
The biomechanics model was derived axiomatically from a consideration of the anatomy of vertebral column when affected by compression fractures. Proof of principle was provided by performing controlled diagnostic blocks in six patients.
The biomechanics model shows that the posterior elements of the vertebral column must subluxate cephalad or caudad in response to deformity of a vertebral body. The model implies that pain may arise from the posterior elements, and predicts that anesthetizing the posterior elements should relieve the pain of compression fractures. Six cases are described in which controlled medial branch blocks relieved the pain of compression fractures of thoracic or lumbar vertebral bodies.
In some patients with vertebral compression fractures, the pain may arise from posterior elements and not the fracture itself. This phenomenon has implications for the interpretation of the outcomes of vertebroplasty in both the active and control arms of sham-controlled studies.
描述并验证一个模型，以解释椎体压缩性骨折后持续性疼痛的生物力学基础。
该生物力学模型从受压缩性骨折影响的脊柱解剖结构出发，通过公理推导得出。通过对 6 名患者进行的控制性诊断阻滞，提供了原理证明。
生物力学模型表明，脊柱的后柱元素必须向前或向后移位，以应对椎体的变形。该模型表明疼痛可能来自后柱，并预测麻醉后柱应该可以缓解压缩性骨折的疼痛。描述了 6 例病例，其中控制性内侧支阻滞缓解了胸腰椎椎体压缩性骨折的疼痛。
在一些椎体压缩性骨折患者中，疼痛可能来自后柱而不是骨折本身。这种现象对假手术对照研究中主动和对照组的椎体成形术结果的解释有影响。
