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Abstract
Purpose
The purpose of this study is to evaluate the efficacy of selective nerve root blocks with vertebroplasty in treatment of patients with osteoporotic compression fracture accompanied spinal stenosis showing neurogenic claudication.
Materials and Methods
Of 80 patients admitted to our orthopedic department for osteoporotic vertebral compression fracture accompanied by neurogenic claudication due to spinal stenosis between May 2010 and September 2011, 40 patients who underwent only vertebroplasty and 40 patients who also underwent an additional selective nerve block were studied with a minimum follow-up period of one year. The two groups were compared for their age, sex, grade of spinal stenosis, bone mineral density (BMD), lordotic angle, pelvic tilt, sacral slope, pelvic incidence, restoration rate of vertebral height, preexisting fracture, intradiscal cement leakage, and for new adjacent vertebral fractures during a follow-up period of at least one year. Statistical analysis was performed using SPSS version 17.0 and statistical significance was determined using the Student t-test and chi-square test with p<0.05.
Results
No statistically significant difference (p≥0.05) in age sex, grade of spinal stenosis, BMD, lordotic angle, pelvic tilt, pelvic incidence, restoration of vertebral height, preexisting fracture, and intradiscal cement leakage was observed between the vertebroplasty only group and the additional selective root block group. However, the incidence of new adjacent vertebral fractures between the groups was 13 of 40 patients in the vertebroplasty only group and four of 40 patients in the selective nerve block addition group; a statistically significant reduction was observed in the nerve block group (p<0.05).
Conclusion
In treatment of patients with osteoporotic compression fracture with neurogenic claudication due to spinal stenosis, addition of selective nerve block to vertebroplasty can lessen pain and the resulting postural change, thereby mitigating dynamic sagittal instability, which in turn results in reduced incidence of new adjacent vertebral fractures. As such, selective nerve block should be considered as a safe, simple, and effective tool for use in prevention of new adjacent vertebral fractures in patients with osteoporotic fracture who are suffering from neurogenic claudication.
Figures and Tables
Figure 1
The method of estimation of vertebral body height restoration rate. (A) Preoperative radiograph; (B) postoperative radiograph. Vertebral body height before compression fracture (Y); Y=(a+c)/2. Anterior height restoration rate (AR); AR=(e-b)/Y×100(%). Middle height restoration rate (MR); MR=(f-d)/Y×100(%).
Table 1
Comparison between the Vertebroplasty Only Group and the Additional Selective Root Block Group
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