title: Post-vertebral augmentation back pain: evaluation and management.
abstract: OBJECTIVE
  Vertebral augmentation is an established treatment for painful osteoporotic vertebral fractures of the spine. Nevertheless, patients may continue to have significant back pain afterward. The purpose of this study was to assess the source of persistent or recurrent back pain following vertebral augmentation.
  
  
  METHODS
  Our institutional review board approved this study. We evaluated 124 consecutive patients who underwent vertebral augmentation for painful osteoporotic vertebral fractures. All patients were evaluated after 3 weeks, 3 months, and 1 year following their procedure. Patients with any type of back pain after their procedure were examined under fluoroscopy.
  
  
  RESULTS
  Thirty-four of 124 (27%) patients were men, and 90/124 (73%) were women. Persistent or recurrent back pain, not due to a new fracture or a failed procedure, was present in 29/124 (23%) patients. The source of pain was most often attributed to the sacroiliac and/or lumbar facet joints (25/29 or 86%). Seventeen of 29 (59%) patients experienced immediate relief after facet joint injection of a mixture of steroid and local anesthetic agents. The remaining 12 (41%) had relief after additional injections. Ten (34%) patients ultimately required radio-frequency neurolysis for long-term relief.
  
  
  CONCLUSIONS
  Back pain after vertebral augmentation may not be due to a failed procedure but rather to an old or a new pain generator, such as an irritated sacroiliac or lumbar facet joint. This is of importance not only for further pain management of these patients but also for designing trials to compare the efficacy of vertebral augmentation to other treatments.
authors: Department of Radiology, Winthrop University Hospital, Mineola, New York 11501, USA. shahmirkamalian@gmail.com
authors: S
authors: S
authors: Kamalian
authors: R
authors: R
authors: Bordia
authors: A O
authors: AO
authors: Ortiz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001416:Back Pain / Q000209:etiology* / Q000628:therapy*; D005260:Female; D050815:Fractures, Compression / Q000601:surgery*; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures; D059408:Pain Management; D012008:Recurrence; D016103:Spinal Fractures / Q000601:surgery*; D013131:Spine / Q000601:surgery*