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

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Purpose: 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. Patients and Methods: 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. Results: 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. Conclusion: RFA-MBN appears to provide meaningful pain relief for patients with VCFs, especially those with higher baseline disability.

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