Disclosures: Navjot Singh, MD: No financial relationships or conflicts of interest

Case Description: The patient presented with thoracic pain for two years, aggravated by physical activity. Pain severity rated as 5/10 on the visual analog scale (VAS). She failed to respond to conservative management using physical therapy, heat, ice and over-the-counter analgesics. Prescription ibuprofen up to 1200mg daily provided some relief. Thoracic MRI spine revealed vertebral wedging and endplate irregularities at T7, T8 and T9 levels. Patient underwent diagnostic fluoroscopic guided bilateral T6, T7, T8, T9 medial branch blocks using 80mg Triamcinolone acetonide with 6ml 0.5% Bupivacaine for a total solution of 8ml (1ml injected at each location). The medial branches were targeted at their anatomical location over the superolateral aspect of the transverse processes.

Setting: Pain management clinic at an academic center.

Patient: 17-year-old female with chronic mid-thoracic back pain secondary to Scheuermann’s disease.

Assessment/Results: Post-procedure, pain severity was rated as 0/10 on the VAS. At her follow up appointment, 18 days later, she continued to report 100% pain relief. She is no longer requiring ibuprofen for her back pain and is able to participate in her school’s physical education and recreational activities without pain.

Discussion: There is currently no literature on interventional spine procedures as treatment for back pain in this patient population. Scheuermann’s disease is a juvenile osteochondrosis of the vertebral endplates causing ≥5° wedge shaped vertebral deformities in at least three adjacent vertebrae and thoracic hyperkyphosis (>45° from T5-T12). First-line treatments include rehabilitation, bracing and analgesics. However, bracing plays a limited role in patients who have reached skeletal maturity and surgery is limited to severe cases. Medial branch blocks are an effective non-surgical treatment for axial thoracic pain in patients who have not responded to first-line conservative management strategies.

Conclusion: Thoracic medial branch nerve blocks are an effective and minimally invasive option to treat chronic thoracic back pain in patients with Scheuermann’s disease.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/thoracic-medial-branch-nerve-blockade-resolves-thoracic-back-pain-secondary-to-scheuermanns-disease-a-case-report/