Optimizing Outcomes in Vertebral Fractures: The Impact of Intercostal Nerve Block on Costal Pain

To assess the effectiveness of intercostal nerve block (INB) for treating osteoporotic vertebral compression fractures (OVCFs) with associated costal pain.

We reviewed clinical data from patients with thoracic OVCF and costal pain admitted to our hospital between January 2021 and January 2024. Patients were divided into an observation group, receiving percutaneous vertebroplasty (PVP) and INB, and a control group, receiving PVP alone. Baseline data, intraoperative parameters, deformity improvement (anterior vertebral body height [AVH] and local Cobb angle), and clinical symptom improvement (visual analog scale [VAS] scores for back and costal pain) were compared between the groups. Risk factors for residual costal pain within the control group were analyzed using multivariable logistic regression, and receiver operating characteristic (ROC) curves were constructed to determine threshold values for the identified risk factors.

The study included 305 patients, 150 in the observation group and 155 in the control group. The groups were statistically comparable in baseline data. Compared with the control group, the observation group had a longer operative time (40.7 ± 5.5 vs. 32.4 ± 3.8 min, p < 0.001) and required more intraoperative C-arm fluoroscopies (30.4 ± 6.3 vs. 21.5 ± 3.9, p = 0.034). Intraoperative bleeding was similar between groups. Both groups showed similarly significant improvements in AVH, local Cobb angle, and thoracic back pain VAS scores one day postoperatively and at the final follow-up. The respective costal pain VAS scores in the control and observation groups were as follows: preoperatively, 7 (6, 8) and 7 (6, 7); one day postoperatively, 4 (2, 5) and 2 (1, 2); and at the final follow-up, 1 (1, 2) and 1 (0, 2). Univariate analysis within the control group identified disease duration, fractured vertebral body width, reduced intervertebral foramen area, and cortical breakdown of the vertebral body's posterior wall as risk factors for residual costal pain. Multivariable analysis confirmed disease duration as an independent risk factor for residual costal pain, with an area under the curve of 0.863. The threshold for self-resolution of costal pain was established at 15.5 days, with a sensitivity of 93.9% and a specificity of 70.0%. Costal pain relief was strongly correlated with disease duration (r = 0.518, p < 0.001).

OVCF-related costal pain can be effectively alleviated by PVP combined with INB; however, INB lengthens operative time and increases radiation exposure. PVP alone can relieve costal pain in patients with a disease duration of ≤ 15.5 days; otherwise, concomitant INB is recommended.