Analgesic interventions for spinal diseases

As a rule vertebroplasty and kyphoplasty can prevent further collapse of a previously broken vertebra. Pain is probably caused by collapse of the porous bone resulting in instability of the vertebra. Stabilization of the vertebra by injecting cement results in a clear improvement in the complaint and a clear reduction in pain resulting in better mobilization. Recent results have, however, cast doubt on the effectiveness of this therapy. Diagnostic nerve blocks on the spinal column are important because the pain is mostly clinically uncharacteristic, the innervation is complex and the pain is subjective. An exact classification can be made using special nerve blocks. Prerequisites for the use of diagnostic nerve blocks are an extensive clinical history and examination of the patient before nerve blocks are carried out. In approximately 15-45% of patients the zygapophyseal joint is the cause of the back pain. Anesthesia of the zygapophyseal joint can be carried out by direct intra-articular application of a local anesthetic or by a block of the medial branch of the posterior branch of each of two spinal nerves. The simplest method is by computed tomography-guided zygapophyseal block. (orig.)