Radiofrequency Ablation of the Medial Branch Nerves for Posterior Element Pain in Chronic Vertebral Compression Fractures: An Anatomical Review and Retrospective Case Series

Vertebral compression fractures (VCFs) cause significant pain and disability, particularly in the elderly and those with osteoporosis, trauma, or malignancy. Medial branch nerve radiofrequency ablation (RFA-MBN) offers a minimally invasive intervention for facetogenic pain in patients with VCFs. This retrospective case study explores the efficacy and clinical outcomes of RFA-MBN in managing VCF-associated pain.

A retrospective chart review of 61 patients with confirmed chronic thoracic or lumbar VCFs who underwent RFA-MBN between 2014 and 2022 at a single academic pain center was conducted. Primary outcomes were self-reported percentage and duration of pain relief. Secondary outcomes included changes in disability index scores. Covariates such as age, gender, number, location, and cause of VCFs, PHQ-9 scores, history of prior vertebroplasty, laterality of RFA-MBN, and time to repeat ablation were evaluated. Statistical analysis was performed using linear mixed-effect models.

The average pain relief was 56.6% over 36.1 weeks. 67% percent of patients experienced at least 50% pain relief for three months, with 47.5% of those patients maintaining relief for six months. A higher pre-disability index was significantly associated with increased pain relief (p=0.007) while none of the other covariates above showed significant associations with the primary outcomes.

RFA-MBN appears to provide meaningful pain relief for patients with VCFs, especially those with higher baseline disability.