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Percutaneous dorsal root ganglion block for treating lumbar compression fracture-related pain

  • Original Article - Functional Neurosurgery - Pain
  • Published:
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Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

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Authors and Affiliations

  1. Department of Neurosurgery, Chang Gung Memorial Hospital, Chia-Yi Branch, Sec 6, Chia Pu West Rd., Pu Tz City, Chia-Yi, Taiwan, 61636

    Wei-Chao Huang, Martin Hsiu-Chu Lin, Ming-Hsueh Lee, Kuo-Tai Chen, Chun-Yu Cheng, Chun-Hsien Lin, Wei Hsun Yang, Ting-Chung Wang & Jen-Tsung Yang

  2. Chang Gung University of Science and Technology, Chia-Yi, Taiwan

    Ming-Hsueh Lee

  3. College of Medicine, Chang Gung University, Tao-Yuan, 33302, Taiwan

    Jen-Tsung Yang

Authors
  1. Wei-Chao Huang
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  2. Martin Hsiu-Chu Lin
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  3. Ming-Hsueh Lee
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  4. Kuo-Tai Chen
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  5. Chun-Yu Cheng
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  6. Chun-Hsien Lin
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  7. Wei Hsun Yang
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  8. Ting-Chung Wang
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  9. Jen-Tsung Yang
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Corresponding author

Correspondence to Jen-Tsung Yang.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (IRB approval number in Chang Gung Memorial Hospital: 201700402B0) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For retrospective studies, informed consent is not required.

No identifying information about the participants is included in the article.

This article does not include any studies with human participants performed by any of the authors.

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Comments

This is a well performed retrospective study on 40 patients with pain following lumbar vertebral compression fractures treated by CT-guided bilateral percutaneous dorsal root ganglion steroid/anesthetic blocks. The authors report a high percentage of durable responders within the first week after the treatment mitigating the lack of a control cohort. They point out that lack of side effects as an advantage compared to the popular procedure of kyphoplasty.

The authors have made a respectable case for their procedure in the treatment of painful lumbar compression fractures unresponsive to non-invasive measures.

Zvi Harry Rappaport

Petah Tiqva, Israel

IRB approval number in Chang Gung Memorial Hospital: 201700402B0

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Huang, WC., Lin, M.HC., Lee, MH. et al. Percutaneous dorsal root ganglion block for treating lumbar compression fracture-related pain. Acta Neurochir 160, 1283–1289 (2018). https://doi.org/10.1007/s00701-018-3535-7

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  • DOI: https://doi.org/10.1007/s00701-018-3535-7

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