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Letter to the Editor

Int J Pain 2022; 13(2): 114-115

Published online December 31, 2022 https://doi.org/10.56718/ijp.22-008

Copyright © The Korean Association for the Study of Pain.

Comments on "Single Photon Emission Computed Tomography in Detection of Costovertebral Joint Injury after Cervical Spine Surgery: A Case Report" by Ko et al.

Yoon Mok Chun1, Sang Ho Lee2

1Department of Rehabilitation Medicine, Wooridul Spine Hospital, 2Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea

Dear Editor:

I recently read the article entitled “Single Photon Emission Computed Tomography in Detection of Costovertebral Joint Injury after Cervical Spine Surgery: A Case Report” by Ko et al. in International Journal of Pain [1]. The authors described their experience of effectively controlling pain that occurred after cervical spine surgery and determined that it was caused by a costovertebral joint injury during the surgery. However, this raises a pertinent issue.

It is unclear that the cervical surgery was the direct cause of the patient’s thoracic pain. Furthermore, the authors did not accurately describe the approach or location of the cervical surgery. The anterior and posterior approaches are commonly used in cervical surgery. In the anterior approach, the patient is placed in the supine position. A small bump or roll is placed between the scapulae to extend the neck slightly and drop the shoulders posteriorly. In contrast, in the posterior approach, the patient is placed in the prone position. Therefore, the patient’s cervical spine is typically in a flexed position, and traction is occasionally applied to the shoulder area. A low degree of force is applied to the body during cervical surgery, and the traction applied to secure the surgical field is usually applied to the lateral sides and not up and down sides. Therefore, it is unlikely that a sufficient force was applied to the rib cage during the surgery that could have damaged the costovertebral joint.

Joint arthropathy is a representative overuse or degenerative injury. In other words, it is a chronic pathological condition caused by repeated micro-damage [2]. These cervical surgery processes may damage the costovertebral joint. However, it is unlikely that costovertebral joint arthropathy occurred during a brief diagnostic cervical surgery. In addition, any joint pain caused by an acute injury without definitive structural changes would have improved within a few days postoperatively as the tissue healed. Modic changes identified on a magnetic resonance image of the thoracic spine usually imply repeated loads on the patient’s thoracic spine, meaning that continuous loading could have been applied to the patient’s costovertebral joint. Furthermore, degenerative disorders including disc and vertebral body disease can result in costovertebral arthropathy [3]. Therefore, costovertebral joint arthropathy, the cause of the patient’s thoracic pain, was more likely due to repeated overuse and degenerative injuries rather than the cervical surgery.

No potential conflict of interest relevant to this article was reported.

  1. Ko BW, Park SJ, Kim KW: Single-photon emission-computed tomography in detection of costovertebral joint injury after cervical spine surgery: a case report. Int J Pain 2022; 13: 36-40.
    CrossRef
  2. Nathan H, Weinberg H, Robin GC, Aviad I: The costovertebral joints, anatomical-clinical observations in arthritis. Arthritis Rheum 1964; 7: 228-40.
    Pubmed CrossRef
  3. Wilson DJ, de Abreu M. IDKD Springer Series: Spine Degeneration and Inflammation, in: Hodler J, Kubik-Huch RA, von Schulthess GK (Eds.) Musculoskeletal Diseases 2021-2024: Diagnostic Imaging, Springer. Copyright 2021, The Author(s). Cham (CH), 2021, pp. 197-213.
    CrossRef

Article

Letter to the Editor

Int J Pain 2022; 13(2): 114-115

Published online December 31, 2022 https://doi.org/10.56718/ijp.22-008

Copyright © The Korean Association for the Study of Pain.

Comments on "Single Photon Emission Computed Tomography in Detection of Costovertebral Joint Injury after Cervical Spine Surgery: A Case Report" by Ko et al.

Yoon Mok Chun1, Sang Ho Lee2

1Department of Rehabilitation Medicine, Wooridul Spine Hospital, 2Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea

Body

Dear Editor:

I recently read the article entitled “Single Photon Emission Computed Tomography in Detection of Costovertebral Joint Injury after Cervical Spine Surgery: A Case Report” by Ko et al. in International Journal of Pain [1]. The authors described their experience of effectively controlling pain that occurred after cervical spine surgery and determined that it was caused by a costovertebral joint injury during the surgery. However, this raises a pertinent issue.

It is unclear that the cervical surgery was the direct cause of the patient’s thoracic pain. Furthermore, the authors did not accurately describe the approach or location of the cervical surgery. The anterior and posterior approaches are commonly used in cervical surgery. In the anterior approach, the patient is placed in the supine position. A small bump or roll is placed between the scapulae to extend the neck slightly and drop the shoulders posteriorly. In contrast, in the posterior approach, the patient is placed in the prone position. Therefore, the patient’s cervical spine is typically in a flexed position, and traction is occasionally applied to the shoulder area. A low degree of force is applied to the body during cervical surgery, and the traction applied to secure the surgical field is usually applied to the lateral sides and not up and down sides. Therefore, it is unlikely that a sufficient force was applied to the rib cage during the surgery that could have damaged the costovertebral joint.

Joint arthropathy is a representative overuse or degenerative injury. In other words, it is a chronic pathological condition caused by repeated micro-damage [2]. These cervical surgery processes may damage the costovertebral joint. However, it is unlikely that costovertebral joint arthropathy occurred during a brief diagnostic cervical surgery. In addition, any joint pain caused by an acute injury without definitive structural changes would have improved within a few days postoperatively as the tissue healed. Modic changes identified on a magnetic resonance image of the thoracic spine usually imply repeated loads on the patient’s thoracic spine, meaning that continuous loading could have been applied to the patient’s costovertebral joint. Furthermore, degenerative disorders including disc and vertebral body disease can result in costovertebral arthropathy [3]. Therefore, costovertebral joint arthropathy, the cause of the patient’s thoracic pain, was more likely due to repeated overuse and degenerative injuries rather than the cervical surgery.

CONFLICT OF INTEREST

No potential conflict of interest relevant to this article was reported.

References

  1. Ko BW, Park SJ, Kim KW: Single-photon emission-computed tomography in detection of costovertebral joint injury after cervical spine surgery: a case report. Int J Pain 2022; 13: 36-40.
    CrossRef
  2. Nathan H, Weinberg H, Robin GC, Aviad I: The costovertebral joints, anatomical-clinical observations in arthritis. Arthritis Rheum 1964; 7: 228-40.
    Pubmed CrossRef
  3. Wilson DJ, de Abreu M. IDKD Springer Series: Spine Degeneration and Inflammation, in: Hodler J, Kubik-Huch RA, von Schulthess GK (Eds.) Musculoskeletal Diseases 2021-2024: Diagnostic Imaging, Springer. Copyright 2021, The Author(s). Cham (CH), 2021, pp. 197-213.
    CrossRef
The Korean Association for the Study of Pain

Vol.14 No.2
December 2023

pISSN 2233-4793
eISSN 2233-4807

Frequency: Semi-Annual

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