The Effect of Vertebroplasty on Costal Pain Related to Osteoporotic Thoracic Compression Fractures in Elderly Patients

Abstract

ObjectiveTo analyze the effect of vertebroplasty on costal pain which develops following osteoporotic thoracic compression fractures (OTCFs).MethodsThe authors reviewed the medical records of 35 patients who underwent vertebral augmentation for the treatment of OTCFs over a five year period. The patients were divided into two groups: the costalgia group included patientswho had costal pain after a vertebral fracture and the non-costalgia group included patients without costalgia. To evaluate the effect of vertebroplasty on costal pain and factors related to costal pain, several factors including: vertebral body fracture type, pedicle injury, bone mineral density, the fracture level and clinical outcome were confirmed with magnetic resonance imaging and chart reviews.ResultsAmong 35 patients, ten patients (28.6%) complained of costal pain with back pain. Only five of the ten patients (50%) had improved costal pain after a vertebroplasty. In the remaining 5 patients, the costal pain was improved through the use of medication including pain killers or a costal block during the follow-up period. Although the incidence of wedge deformity in the costal group was low(10%), there was no significant relationship to the incidence of costal pain statistically. Pedicle injury, bone mineral density and the fracture level had no significant relation to costal pain.ConclusionThe patients with wedge type, OTCFs may have a low incidence of costal pain as compared to those patients with bi-concave and crush deformities. The vertebroplasty effect on costal pain may not be effective. Therefore, before doing vertebroplasty, the surgeon should advise patients of this potential outcome in those treated for OTCFs.

Thoracic paravertebral block versus local infiltration anesthesia for percutaneous kyphoplasty to treat osteoporotic vertebral compression fractures combined with intercostal neuralgia: a randomized controlled trial

“…The reason why patients with vertebral fractures experience non-midline pain, even when signi cant nerve impingement or compression is not evident on MRI scans, remains unknown [11] . Choi et al suggested that post-fracture vertebral mid-column injuries irritate the extravertebral ligaments of the foramen magnum, causing ligamentous edema, distortion, and consequent compression and traction of the intercostal nerves [17] . Chen et al noted a signi cant correlation among the percentage of severe thoracic spine fractures or mid-thoracic spine fractures, rate of intervertebral foraminal area reduction, and incidence of intercostal pain [18] .…”

“…However, some scholars have pointed out that some patients do not achieve satisfactory results with PKP. Choi et al observed that among ten patients with OVCF combined with IN who underwent vertebroplasty, only 50% of the patients experienced relief from IN following PKP, while the pain still persisted in the remaining patients [17] .…”

Selective nerve block for the treatment of neuralgia in Kummell’s disease: A case report

“…Recent studies have shown that patients often also have intractable neuralgia, which is the key determinant of remnant pain following PKP[ 12 , 17 , 18 ]. The incidence of intercostal neuralgia in patients with lower thoracic compression fractures has been reported to be 28.6%[ 17 ]. Neuralgia mainly manifests as diffuse radiating pain along the area innervated by the intercostal nerve and lower abdomen.…”