Nuffield Orthopaedic Centre NHS Trust, Oxford, OX3 7LD, UK.
Eur Radiol. 2011 Aug;21(8):1772-8. doi: 10.1007/s00330-011-2115-5. Epub 2011 Apr 13.
Recent publications compared treatment of vertebral fractures reporting improvement in the majority but with no significant difference between the local anaesthetic and vertebroplasty groups. Potential explanations include placebo response or therapeutic response to the "control procedure". We investigated whether preliminary facet joint injection can identify those patients whose pain arises from paravertebral structures rather than the vertebral insufficiency fracture itself.
Patients referred for treatment by vertebroplasty were first offered local anaesthetic and steroid facet joint injection (FJI) at the most painful level. Those who failed to respond were offered a vertebroplasty.
Ninety one patients referred, 16 went straight to vertebroplasty. Sixty one of 75 were initially offered FJI. Twenty one were successful; two relapsed, had further FJIs with good results; three declined treatment; 5 had temporary benefit; 1 died from unrelated causes. Of 29 who failed to respond to FJIs, 24 underwent vertebroplasty and 23 had a successful outcome.
A third of patients technically suitable for vertebroplasty responded beneficially to FJI. In this group the pain mediator maybe one of instability and overload on the facet joints produced by adjacent wedge fracture. This protocol allows more selective and more successful vertebroplasty.
最近的出版物比较了治疗椎体骨折的方法，报告称大多数治疗方法都有所改善，但局部麻醉和经皮椎体成形术组之间没有显著差异。潜在的解释包括安慰剂反应或对“对照程序”的治疗反应。我们研究了初步的关节突关节注射是否可以识别出那些疼痛源自椎旁结构而不是椎体骨质疏松性骨折本身的患者。
首先向因椎体成形术而就诊的患者提供局部麻醉和皮质类固醇关节突关节注射（FJI）在最痛的水平。那些对治疗没有反应的患者接受椎体成形术治疗。
91 名被转介的患者中，16 名直接接受了椎体成形术。75 名患者中有 61 名最初接受了 FJI。21 例成功；2 例复发，进一步的 FJIs 效果良好；3 例拒绝治疗；5 例有暂时缓解；1 例死于无关原因。在 29 例对 FJIs 无反应的患者中，24 例接受了椎体成形术，23 例获得了成功的结果。
三分之一技术上适合椎体成形术的患者对 FJI 反应良好。在这一组中，疼痛介质可能是由相邻楔形骨折引起的关节突关节不稳定和过载。这种方案允许更有选择性和更成功的椎体成形术。
