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Lin F, Zhang Y, Wu T, et al. Local Anesthetic and Steroid Injection to Relieve the Distal Lumbosacral Pain in Osteoporotic Vertebral Compression Fractures of Patients Treated with Kyphoplasty. Pain Physician. 2022 Jul;25(4):E581-E587. (Original study)
Abstract

BACKGROUND: Percutaneous kyphoplasty (PKP) is widely used in osteoporotic vertebral compression fractures (OVCF). But in some patients, distal lumbosacral pain (DLP) persists even after treatment and affects their quality of life.

OBJECTIVE: To investigate the effectiveness of local anesthetic and steroid injection in improving DLP after PKP.

STUDY DESIGN: A prospective, randomized, and controlled clinical trial.

SETTING: The study was carried out in a university hospital.

METHODS: A total of 150 patients were included in this study and randomly divided into 2 groups of 75 patients each. Patients in the control group (PKP) underwent PKP, and those in the observation group (PKP + LAI) received an injection of lidocaine + triamcinolone acetonide suspensions during the surgery. The visual analog scale (VAS) of the fracture site, Oswestry disability index (ODI), and the rate of patients with lower back pain were compared between the 2 groups at 1 day, 3 days, 1 week, 1 month, and 3 months after the surgery.

RESULTS: One hundred thirty-nine patients completed the entire postoperative follow-up schedule, with 70 patients in the PKP group and 69 cases in the PKP + LAI group. The VAS and ODI in the PKP + LAI group were significantly lower than those in the PKP group 1 day, 3 days, 1 week, and 1 month after the surgery; there was no significant difference  3 months after the operation. The rate of patients with lower back pain in the PKP + LAI group 1 day, 3 days, and 1 week after the operation was significantly lower than that in the control group; there was no significant difference 1 month and 3 months after the operation.

LIMITATIONS: The number of cases was small, and the follow-up time was short.

CONCLUSION: Local anesthetic and steroid injection improved the short-term clinical outcome of PKP for OVCF, which will enhance the confidence of patients in performing out-of-bed activities and functional exercises early after the operation.

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RCT comparing the effect of the addition of steroid and LA to patients having percutaneous vertebral kyphoplasty (PVK) to patients who have PVK in isolation. The group studied were those with osteoporotic vertebral compression fractures. The authors conclude that the injection group had better pain and disability scores up to 1 month post-procedure. This may have implications on speed of their rehabilitation. The groups studied are small and the results of this study will need to be reproduced before it can be adopted more widely.
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