Abstract
Introduction: Osteoporotic vertebral compression fractures (VCFs) in the elderly patient can cause significant pain and lead to restrictions in daily life activities. Augmentation procedures (vertebroplasty and kyphoplasty) have been reported as a standard treatment of VCFs in cases of unresponsiveness to conservative treatment. However, patients who have remnant pain after augmentation procedures are a challenge to doctors and require the definite treatment. We have injected hyperosmolar dextrose solution into the lumbosacral medial branch and bilateral sacro-iliac joint for remnant buttock pain and report our results.
Patients and methods: Thirty-six patients with remnant pain were identified after augmentation procedures on 321 patients. Remnant pain was defined as occurring when patients complained of pain 2 days postoperatively. Patients were treated with bilateral lumbosacral (L4, L5, S1) medial branch injections and bilateral sacro-iliac joint injection using hyperosmolar dextrose solution. Injection was given 3–5 days following vertebroplasty and kyphoplasty procedures. All remnant pain patients were evaluated at intervals of 1–2 weeks and received additional injections if they still reported pain.
Results: The average number of injections was 2.31. Pain intensity measured using a visual analogue scale (VAS) decreased from 8.78 before augmentation procedures to 4.33 after augmentation procedures to 2.67 after the first injection procedure and 1.97 after the second injection procedure. Successful outcome was determined if the pain reduction exceeded 50% relief from the postaugmented buttock pain state. Five of the 36 patients (13.9%) did not respond favourably to injection (pain reduction less than 50%), and 31 patients (86.1%) showed successful responses.
Conclusions: Hyperosmolar dextrose solution injection into the lumbosacral medial branch and bilateral sacro-iliac joint of the patient who has a remnant pain after augmentation procedures for VCFs is one method that decreases the symptoms.