Department of Neurosurgery, Chang Gung Memorial Hospital, Chia-Yi Branch, Sec 6, Chia Pu West Rd., Pu Tz City, Chia-Yi, Taiwan, 61636.
Chang Gung University of Science and Technology, Chia-Yi, Taiwan.
Acta Neurochir (Wien). 2018 Jun;160(6):1283-1289. doi: 10.1007/s00701-018-3535-7. Epub 2018 Apr 26.
The pain of acute compression fracture in the lumbar spine may be refractory to conservative treatment, and surgery is not an optimal choice for the elderly or infirm individuals. Moreover, even vertebroplasty can cause many side effects such as chemical leak, adjacent segment instability, and residual pain. Percutaneous dorsal root ganglion block (PDRGB) possibly is an alternative therapeutic option. In this study, we evaluated the efficacy of pain relief and the rate of adjacent level compression fracture in patients with acute compression fracture of the lumbar spine.
We retrospectively reviewed 40 patients with lumbar compression fracture from 2013 to 2015. The patients were treated with navigation-assisted CT-guided PDRGB with steroid at the pathological level and at the adjacent level above and below. Therapeutic response was evaluated using the Numerical Rating Scale (NRS); and an optimal, acceptable, and unfavorable outcome were analyzed.
Among the 40 patients treated, initial pain relief on the first day was dramatic, and the average NRS did not change significantly up to the first-year follow-up. The highest percentage of a good outcome, at 90% (37.5% with an optimal outcome, 52.5% with an acceptable outcome), was reported at 1 week postoperatively. The percentage of optimal outcomes increased even at the 1-year follow-up. No adjacent compression fracture was found in the group treated with PDRGB alone at the 1-year follow-up.
PDRGB is a simple, safe, and minimally invasive procedure that showed immediate and prolonged improvement of pain in lumbar osteoporotic compression fracture patients who failed conservative treatment or had residual pain after vertebroplasty. However, continuous medication for osteoporosis was still required.
腰椎急性压缩性骨折的疼痛可能对保守治疗无反应，手术不是老年人或体弱患者的最佳选择。此外，即使是椎体成形术也会引起许多副作用，如化学泄漏、相邻节段不稳定和残留疼痛。经皮背根神经节阻滞（PDRGB）可能是一种替代的治疗选择。在这项研究中，我们评估了对急性腰椎压缩性骨折患者的疼痛缓解效果和相邻水平压缩性骨折的发生率。
我们回顾性分析了 2013 年至 2015 年的 40 例腰椎压缩性骨折患者。患者采用导航辅助 CT 引导下 PDRGB 联合皮质类固醇治疗，在病变水平及上下相邻水平进行治疗。采用数字评分量表（NRS）评估治疗反应；并分析了最佳、可接受和不满意的结果。
在接受治疗的 40 例患者中，第 1 天的初始疼痛缓解效果显著，直至第 1 年随访时平均 NRS 无明显变化。术后第 1 周报告的最佳结果比例最高，为 90%（37.5%为最佳结果，52.5%为可接受结果）。即使在第 1 年随访时，最佳结果的比例也有所增加。在单独接受 PDRGB 治疗的组中，在第 1 年随访时未发现相邻的压缩性骨折。
PDRGB 是一种简单、安全、微创的方法，可改善经保守治疗无效或椎体成形术后残留疼痛的骨质疏松性压缩性骨折患者的疼痛，并能立即和持续缓解疼痛。然而，仍需要持续治疗骨质疏松症。
