To evaluate the outcomes of medial branch block in facet joint pain for osteoporotic compression fracture and utilize multiple regression, the relationship between their impact on treatment outcome and other factor, such as the radiologic finding, clinical parameters was analyze.
Fifty-three patients with axial back pain from osteoporotic compression fracture were enrolled. The clinical outcomes were measured by Verbal Numeric Rating Scale (VNS) and Oswestry Disability Index (ODI) before treatment, 2 weeks, 3 months, and 12 months after the medial branch block. Radiographic analysis included measurement of overall sagittal alignment, collapsed vertebral height, and vertebral kyphotic angle. After 12 months, patients' satisfaction was classified to five categories: excellent, good, fair, poor or fail. Statistical analysis of both radiographic and clinical parameters along with treatment outcome was performed to determine any significant correlations between the two.
VNS and ODI was improved 2 weeks after the injection and continued to improve until 12 months. Significant improvement with significant pain relief (>40%), functional improvement (>20%), and the patients rated their satisfaction level as "excellent" or "good" at 12 months after the first injection were observed in 78.9%. The radiographic and clinical parameters were not significantly correlated with treatment outcome.
Our retrospective study demonstrated that the medial branch block provided significant pain relief and functional recovery to the patients with osteoporotic spinal compression fractures complaining of continuous facet joint pain after vertebroplasty or conservative treatment. A placebo-controlled prospective randomized double-blind study should be conducted in the future to evaluate the treatment effects.
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Thyroid carcinoma is the commonest endocrinological malignancy. After papillary thyroid carcinoma (PTC), follicular thyroid carcinoma (FTC) is the second most common histological subtype. Common presentations of FTC include a solitary thyroid nodule and cervical lymphadenopathy. The incidence of individuals diagnosed with thyroid cancer showing initially distant metastatic disease ranges from 1 to 9%. Also, the incidence of solitary bone metastasis from thyroid is only 2 to 3%. We report a case of a patient with FTC whose initial presentation was low back pain and right buttock pain due to vertebral metastasis rather than the usual neck lumps or symptoms of thyroid disease.
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Parkinson's disease(PD) is characterized clinically by bradykinesia, rigidity, tremor, and disturbance of posture and equilibrium. A higher incidence of fractures in PD patient has been reported, however the studies of musculoskeletal complications in PD have been negligible.
The purposes of this study were to investigate the incidence of osteoporosis and spinal compression fracture in PD patients and to evaluate whether the incidence were affected by the severity of PD.
Bone mineral density(BMD) in 21 patients(5 males and 16 females) with idiopathic PD was measured by dual energy X-ray absorptiometry(DXA) and compared with an age adjusted control group(32 females). The patients were divided into two groups according to the Hoehn and Yahr(H-Y) stage as mild or severe and the BMD was compared. Simple x-ray studies of thoracolumbar spine were performed to find out the presence of spinal compression fractures.
The results showed that the BMD of PD patients was significantly lower than control subjects. The PD patients with high H-Y stage(severe group) had lower BMD scores with no statistical significance. The spinal compression fractures were noted mainly at mid-thoracic area and thoraco-lumbar junction. Spinal t-score in patients with a compression fracture was significantly reduced. No significant correlation exists between back pain and a compression fracture.
Objective: To evaluate the effects of facet joint injection in the conservative management of osteoporotic spinal compression fractures
Method: Among 27 patients with osteoporotic spinal compression fractures which were confirmed by plain radiography and bone densitometry (dual energy x-ray absorptiometry), 9 patients were control group and 18 patients received facet joint injection treatment. Facet joint injection of thoracolumbar spine was done under fluoroscopic guide with 1% lidocaine 1 ml and triamcinolone 10 mg at each joint above and below the level of compression fracture at both side. Main outcome measures were visual analog scale (VAS), spinal movement (modified Schober's and lateral bending test), and physical activity from bed-ridden state (grade I) to outdoor activity without pain (grade V). The treatment outcomes were assessed before injection, 2 weeks and 4 weeks after injection.
Results: There were significant decrease in VAS at 2 weeks and 4 weeks after injection in the study group (p＜0.05). Physical activity was significantly improved at post injection 2 weeks and 4 weeks (p＜0.05). There were no significant differences between the two groups in spinal movement.
Conclusion: These results suggest that facet joint injection of thoracolumbar spine is useful method in the conservative management of painful osteoporotic compression fractures.
Osteoporosis is the most common generalized skeleta l disease, which lays a significant socioeconomic burden to Korea. The early diagnosis and treatment of osteoporosis are of the great interest to minimize the economic consequence. We have studied vertebral BMD and bone scan of 30 patients with osteoporotic compression fractures. The purpose of this study was to in vestigate the effect of osteoporotic compression fracture on bone mineral density(BMD). We have measured the vertebral heights, vertebral bone mineral density, and bone scan counts of vertebral bodies on osteoporotic patients. Vertebral BMD was measured from T12 to L4 using dual photon absorptiometry. Anterior(Ha), middle(Hm), and posterior(Hp) height of vertebrae were measured from T12 to L4, and the spinal deformity indices(Ha/Hp, Hm/Hp, and Hp/Hi ratios) were calculated. The bone scan counts were measured from T12 to L4, and bone scan ratios were calculated. The BMD of fractured vertebrae was significantly higher than that of non-fractured vertebrae. The spinal deformity indices were not correlated to the BMD of fractured vertebrae. The bone scan ratio was correlated to the BMD of fractured vertebrae. This study suggests that the increased BMD observed in fractured vertebrae is related to metabolic effect of compression fractures rather than mechanical effect.
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