Vertebrplasty, Kyphoplasty and Occipital Neuralgia for the PM&R Boards

PainExam Podcast Show Notes Compression Fractures, Vertebroplasty, Kyphoplasty & Occipital Neuralgia for the ABA Pain Medicine Boards

In this episode of the PainExam Podcast, Dr. David Rosenblum reviews two frequently tested topics on the ABA Pain Medicine Board Examination: Occipital Neuralgia and Vertebral Compression Fractures, including the indications, techniques, complications, and evidence surrounding vertebroplasty and kyphoplasty.

Whether you are preparing for the ABA Pain Medicine Boards, ABPM, ABIPP, FIPP, or simply looking to strengthen your interventional pain knowledge, this episode covers essential board pearls, anatomy, diagnosis, imaging findings, and treatment options.

Episode Highlights Occipital Neuralgia

Topics discussed include:

• Anatomy of the greater, lesser, and third occipital nerves

• C2 dorsal ramus anatomy and clinical relevance

• Diagnostic criteria for occipital neuralgia

• Differentiating occipital neuralgia from:

  • Cervicogenic headache

  • Migraine

  • Cluster headache

  • Tension headache

• Physical examination findings

• Occipital nerve blocks

• Pulsed radiofrequency ablation

• Cryoneurolysis

• Peripheral nerve stimulation (PNS)

Board Pearl

The greater occipital nerve originates from the dorsal ramus of C2 and temporary pain relief following a diagnostic occipital nerve block strongly supports the diagnosis.

Vertebral Compression Fractures

Topics reviewed include:

• Osteoporotic vertebral compression fractures

• Thoracolumbar fracture patterns

• MRI findings

• STIR sequence interpretation

• Patient selection for vertebral augmentation

• Conservative treatment versus intervention

• Vertebroplasty technique

• Kyphoplasty technique

• Cement leakage and other complications

• Evidence supporting vertebral augmentation procedures

Board Pearl

Bone marrow edema on MRI STIR imaging is one of the most important findings suggesting an acute compression fracture.

Kyphoplasty vs Vertebroplasty Vertebroplasty

• Direct injection of PMMA cement into the vertebral body

• Stabilizes micro-motion within the fracture

• Can provide rapid pain relief

Kyphoplasty

• Balloon tamp creates a cavity before cement placement

• May partially restore vertebral body height

• May reduce risk of cement extravasation

• Often preferred in selected patients with significant vertebral collapse

Commonly Tested Complications

• Cement leakage

• Pulmonary cement embolism

• Adjacent level fractures

• Infection

• Neurologic injury (rare)

High-Yield ABA Pain Medicine Keywords

• Occipital Neuralgia

• Greater Occipital Nerve

• C2 Dorsal Ramus

• Third Occipital Nerve

• Cervicogenic Headache

• Peripheral Nerve Stimulation

• Vertebral Compression Fracture

• Kyphoplasty

• Vertebroplasty

• PMMA Cement

• STIR MRI

• Osteoporosis

• Cement Extravasation

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References

1. Margetis K, Patel A, Petrone B, et al. Percutaneous Vertebroplasty and Kyphoplasty. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; Updated April 6, 2025. Available at:
   https://www.ncbi.nlm.nih.gov/books/NBK525963/

2. Daher M, Kreichati G, Kharrat K, Sebaaly A.
   Vertebroplasty versus Kyphoplasty in the Treatment of Osteoporotic Vertebral Compression Fractures: A Meta-Analysis.
   World Neurosurgery. 2023;171:65-71.

3. Masala S, Fiori R, Massari F, Simonetti G.
   Kyphoplasty: Indications, Contraindications and Technique.
   Radiologia Medica.
   2005;110(1-2):97-105.

4. Headache Classification Committee of the International Headache Society (IHS).
   International Classification of Headache Disorders (ICHD-3).
   Cephalalgia. 2018.

5. Bogduk N.
   The Clinical Anatomy of the Cervical Dorsal Rami.
   Spine-related anatomy and occipital nerve pain syndromes.

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