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

Chinar D Sanghvi,1 Anthony Thomas Gordon,2 Naileshni Singh,1 Frank H Willard,3 Yunyi Ren,4 Machelle D Wilson,4 David Copenhaver1 1Department of Anesthesiology and Pain Medicine, University of California – Davis, Sacramento, CA, USA; 2Department of Internal Medicine, St. Mary Medical Center, Long Beach, CA, USA; 3Department of Biomedical Sciences and Anatomy, University of New England College of Osteopathic Medicine, Biddeford, ME, USA; 4Department of Public Health Sciences, Division of Biostatistics, University of California – Davis, Sacramento, CA, USACorrespondence: Chinar D Sanghvi, Department of Anesthesiology and Pain Medicine, University of California – Davis, 4860 Y St #2700, Sacramento, CA, 95817, USA, Email [email protected]: 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.Keywords: vertebral compression fracture, radiofrequency ablation, osteoporosis, back pain