[Pain Management] L2 Spinal Nerve–Block Effects on Acute Low Back Pain From Osteoporotic Vertebral Fracture

[Justin]

The Journal of Pain
Volume 10, Issue 8, Pages 870-875 (August 2009)

L2 Spinal Nerve–Block Effects on Acute Low Back Pain From Osteoporotic Vertebral Fracture

Seiji Ohtori, a, Masaomi Yamashitaa, Gen Inouea, Kazuyo Yamauchia, Munetaka Suzukia, Sumihisa Oritaa, Yawara Eguchia, Nobuyasu Ochiaia, Shunji Kishidaa, Masashi Takasoa and Kazuhisa Takahashia

aDepartment of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan

Abstract
Elderly patients with osteoporosis sometimes experience lumbar vertebral fracture and may feel diffuse nonlocalized pain in the back, the lateral portion of the trunk, and the area surrounding the iliac crest. The pattern of sensory innervation of vertebral bodies remains unclear. Some sensory nerves from the L2 and L5 vertebral bodies may enter the paravertebral sympathetic trunks and reach the L2 dorsal root ganglion. Our randomized controlled study was to clarify the effect of L2 spinal nerve block on low back pain originating from acute osteoporotic lumbar vertebral fracture. Patients with low back pain originating from acute L3 or L4 osteoporotic vertebral fractures received a spinal nerve root block (L2 block group, n = 30) or subcutaneous injection (control, n = 30). Both groups received 1.5 mL of 1% lidocaine. The visual analog scale score, Roland Morris Disability Questionnaire, and Short Form questionnaire were examined before and after treatment. In both groups, spinal nerve blocks were significantly effective in alleviating low back pain (P < .05). One hour, 1 week, and 2 weeks after treatment, the visual analog scale score improved more in the L2 block group than in the control group (P < .05). From 1 month to 4 months after treatment, there were no significant differences in the pain scores between groups (P > .05). We conclude that L2 spinal nerve block for acute L3 or L4 osteoporotic vertebral body fracture was effective for 2 weeks, but it had no long-term effects on pain and social function.

Perspective
L2 spinal nerve block treatment for L3 or L4 osteoporotic vertebral body fracture was effective. This results suggest that the L2 dorsal root ganglion may innervate the L3 and L4 vertebral bodies in humans. L2 spinal nerve block for lumbar osteoporotic vertebral fracture may be a useful strategy to treat acute low back pain.

Copyright © 2009 The American Pain Society. All rights reserved

[mark-Perth]

Hi Justin

Can U also post the other papers I past onto you regarding the L2 DRG blocks a few months ago. As I have mentioned before I have had this proceedure more than 20 times in both the left and right side. There is also proof from the other papers that the nerve that runs thru that area sometimes runs thru the L1 DRG which is also recommended to be burned as well at the same time. Its not worth just having the one level done, just get all 4 done in one proceedure, it may hurt alittle more but is worth it instead of 4 visits to the hospital. I would rather suffer once rather than 4 times but ive had times where ive had 20 blocks done in one session but my PS has only ever done that on me as he knows that I can handle it and prefer that. The L2 blocks will also help with disc pain in that area and also below that level as well but not all the way down to S1 as the nerves branch out before there and run down the outside of the legs. Numbness will also result thru that area. It never phased me not feeling my legs but others I have know would prefer the pain over the numbness but the rhizotomies R not permanent anyway so even if U dont like the numbness it will return to normal soon enough. From my experience with rhizotomies they last longer the more times the same nerves R ablated. They would last about double the time each time I had it done with the first only lasting about a month but getting longer each time. I never got total painrelief from this but it did help reduce the pain enough to enable me to exercise and strengthen and stopped alot of the muscle spasms. The only prob is that it masks the pain and can result in worse pain when it returns due to U feeling better than U R and often doing too much. The DRG blocks R alot different to the medial branch blocks as the nerve also controls movement, not just feeling. If the PS stuff up U can loose movement ability so it needs to be done by a very good neuro-anaethetist with experience and knowledge with it. I had one time they got the movement side of the nerve and U dont ever want to suffer with that. My PS heard words come out of my mouth that he had never heard before as it was excruciating but we had a good laugh after . My leg started to move and kick around so violently that 2 nurses were unable to stop it and were being lifted off ground until the needle was removed from the nerve. If he had burned the nerve in that spot I wouldnt have been able to walk properly. Luckliy they know from your reaction whether they get the correct spot as U have to be awake for the proceedure which isnt that great. I was fine with it but I remember meeting a guy that had it done before me and he was a big guy and was balling his eyes out in pain after and was never having it done again. I think a few days of bad pain is fine if it helps over the long term. I think it would be wise to post also on here the paper I forwarded that explains the complications that can occur with this operation as people should know that before having that proceedure as there R risks involved. The other papers date back to the mid 1990's.
Its worth a try I feel before having major surgery as I was able to hold off having surgery for 10yrs with repeated L1 and L2 bilateral blocks. Not all PS will agree that this proceedure is worth it as the results the my PS got were only about 30% success and also required people to do extensive rehab after which most people just dont do enough of, if any at all.

If anyone wants to know more about it just ask me.

Mark

[Justin]

Hi Justin

Can U also post the other papers I past onto you regarding the L2 DRG blocks a few months ago.

Hey Mark,

I will pull these up and post the abstracts for the benefit of the community soon.

Thanks!