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Facet Pain in Thoracic Compression Fractures


Raj Mitra, MD, Stanford School of Medicine—Physical Medicine and Rehabilitation, 450 Broadway St., Redwood City, CA 940663, USA. Tel: 650-721-7627; Fax: 650-721-3470; E-mail:


Objective.  To determine if thoracic facet joints may be a significant secondary pain generator in patients with compression fractures. Traditionally, pain from vertebral compression fractures has been attributed to vertebral body itself. Compression fractures have been shown to increase thoracic kyphosis and thereby increase the thoracic flexion moment; these changes eventually increase the shear stress on the posterior elements.

Design.  We present a small case series of patients with thoracic compression fractures managed with intra-articular facet injections.

Setting.  Tertiary care academic medical center.

Participants.  Two patients with thoracic compression fractures.

Interventions.  The subjects received fluoroscopically guided thoracic facet steroid injections for pain management.

Main Outcome.  Change in verbal analog pain score.

Results.  Patients with thoracic compression fractures received significant long-lasting relief after receiving fluoroscopically guided intra-articular injections.

Conclusion.  Facet joints may be abnormally stressed due to the increasing thoracic flexion moment in anterior compression fractures, which may serve as a secondary pain generator; intra-articular facet blocks may be an alternative to vertebroplasty.