The Pain of Vertebral Compression Fractures Can Arise in the Posterior Elements

• Pain Medicine

  Volume 11, Issue 11, pages 1666–1673, November 201

  1. Nikolai Bogduk MD, 
  2. John MacVicar MB, ChB, 
  3. James Borowczyk MB, ChB

  Article first published online: 2 NOV 2010

Abstract

Objectives.  To describe and test a model to explain the biomechanical basis for persistent pain after compression fractures of the vertebral body.

Methods.  The biomechanics model was derived axiomatically from a consideration of the anatomy of vertebral column when affected by compression fractures. Proof of principle was provided by performing controlled diagnostic blocks in six patients.

Results.  The biomechanics model shows that the posterior elements of the vertebral column must subluxate cephalad or caudad in response to deformity of a vertebral body. The model implies that pain may arise from the posterior elements, and predicts that anesthetizing the posterior elements should relieve the pain of compression fractures. Six cases are described in which controlled medial branch blocks relieved the pain of compression fractures of thoracic or lumbar vertebral bodies.

Conclusions.  In some patients with vertebral compression fractures, the pain may arise from posterior elements and not the fracture itself. This phenomenon has implications for the interpretation of the outcomes of vertebroplasty in both the active and control arms of sham-controlled studies.

Facet Pain in Thoracic Compression Fractures

Pain Medicine

Volume 11, Issue 11, pages 1674–1677, November 2010

1. Raj Mitra MD, 
2. Huy Do MD, 
3. Todd Alamin MD, 
4. Ivan Cheng MD

Article first published online: 1 OCT 2010

Abstract

Objective.  To determine if thoracic facet joints may be a significant secondary pain generator in patients with compression fractures. Traditionally, pain from vertebral compression fractures has been attributed to vertebral body itself. Compression fractures have been shown to increase thoracic kyphosis and thereby increase the thoracic flexion moment; these changes eventually increase the shear stress on the posterior elements.

Design.  We present a small case series of patients with thoracic compression fractures managed with intra-articular facet injections.

Setting.  Tertiary care academic medical center.

Participants.  Two patients with thoracic compression fractures.

Interventions.  The subjects received fluoroscopically guided thoracic facet steroid injections for pain management.

Main Outcome.  Change in verbal analog pain score.

Results.  Patients with thoracic compression fractures received significant long-lasting relief after receiving fluoroscopically guided intra-articular injections.

Conclusion.  Facet joints may be abnormally stressed due to the increasing thoracic flexion moment in anterior compression fractures, which may serve as a secondary pain generator; intra-articular facet blocks may be an alternative to vertebroplasty.