J Korean Med Sci.  2005 Dec;20(6):1023-1028. 10.3346/jkms.2005.20.6.1023.

Percutaneous Vertebroplasty and Facet Joint Block

• Kim TK
• Kim KH
• Kim CH
• Shin SW
• Kwon JY
• Kim HK
• Baik SW

• KMID: 2157756
• DOI: http://doi.org/10.3346/jkms.2005.20.6.1023

Abstract

It is surprising that about 24% of patients with benign osteoporotic vertebral fracture die within a year from respiratory infection and urinary tract infection because of coughing and voiding difficulties, depending on the sites of compression fractures. We reviewed 500 patients on whom percutaneous vertebroplasty (PVP) was performed, at 612 levels in terms of patient selection, operation technique, medication, and clinical outcomes during the follow-up course for 2 yr study period. To confirm the most painful level among the multiple fracture sites, physical examination after facet joint block under the fluoroscope was the most reliable method. The mean total lumbar spine fracture threshold of bone mineral density was 0.81+/-0.05 g/cm2. The mean changes of numeric rating scale scores, Oswestry Disability Index except sex life, and Karnofsky performance status were -72.00, -83.50 and +60.62% in the osteoporosis group and -51.89, -45.02, and 69.03% in the tumor group. Complications related to the procedure were lateral spinal cord damage, transient paresthesia and transient hypotension. PVP with facet joint block is a profitable method for the vertebral compression fracture because of low risk and short duration of procedure with a high chance to result in pain relief and early mobilization.

Keyword

Zygapophyseal Joint; Facet Joint Block; Percutaneous Vertebroplasty; Pain Clinics; Spinal Fractures

MeSH Terms

Aged
Bone Cements/therapeutic use
Female
Follow-Up Studies
Humans
Injections, Spinal
Male
Middle Aged
Nerve Block
Orthopedic Procedures
Pain/physiopathology/surgery
Research Support, Non-U.S. Gov't
Spinal Cord Compression/physiopathology/*surgery
Spinal Fractures/physiopathology/*surgery
Surgical Procedures, Minimally Invasive
Zygapophyseal Joint

Reference

1. Haczyński J, Jakimiuk A. Vertebral fractures: a hidden problem of osteoporosis. Med Sci Monit. 2001. 7:1108–1117.

2. Gaughen JR Jr, Jensen ME, Schweickert PA, Kaufmann TJ, Marx WF, Kallmes DF. Lack of preoperative spinous process tenderness does not affect clinical success of percutaneous vertebroplasty. J Vasc Interv Radiol. 2002. 13:1135–1138.

3. Higgins KB, Harten RD, Langrana NA, Reiter MF. Biomechanical effects of unipedicular vertebroplasty on intact vertebrae. Spine. 2003. 28:1540–1548.

4. Sherry MM, Greco FA, Johnson DH, Hainsworth JD. Breast cancer with skeletal metastases at initial diagnosis. Distinctive clinical characteristics and favorable prognosis. Cancer. 1986. 58:178–182.

5. Sherry MM, Greco FA, Johnson DH, Hainsworth JD. Metastatic breast cancer confined to the skeletal system. An indolent disease. Am J Med. 1986. 81:381–386.

6. Kallmes DF, Jensen ME. Percutaneous vertebroplasty. Radiology. 2003. 229:27–36.

7. McGraw JK, Cardella J, Barr JD, Mathis JM, Sanchez O, Schwartzberg MS, Swan TL, Sacks D. SIR Standards of Practice Committee. Society of Interventional Radiology quality improvement guidelines for percutaneous vertebroplasty. J Vasc Interv Radiol. 2003. 14:827–831.

8. Niv D, Gofeld M, Devor M. Causes of pain in degenerative bone and joint disease: a lesson from vertebroplasty. Pain. 2003. 105:387–392.

9. Minart D, Vallẽe JN, Cormier E, Chiras J. Percutaneous coaxial transpedicular biopsy of vertebral body lesions during vertebroplasty. Neuroradiology. 2001. 43:409–412.

10. Johnell O, Scheele WH, Lu Y, Reginster JY, Need AG, Seeman E. Additive effects of raloxifene and alendronate on bone density and biochemical markers of bone remodeling in postmenopausal women with osteoporosis. J Clin Endocrinol Metab. 2002. 87:985–992.

11. Kim KH, Lee HJ, Baik SW, Kim HK, Kwon JY, Kim CH. Comparison of bone mineral density of lumbar spine in osteoporotic patients treated with percutaneous vertebroplasty. Korean J Anesthesiol. 2004. 46:302–305.

12. Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ. 1996. 312:1254–1259.

13. Kim KH, Yoon JY. Measurement of bone mineral density of lumbar spine in osteoporotic patients treated with percutaneous vertebroplasty. Korean J Anesthesiol. 2003. 45:749–753.

14. Fabian CJ, Kimler BF. Chemoprevention of breast cancer: implications for postmenopausal women. Drugs Aging. 2002. 19:43–78.