Effect of medial branch block in chronic facet joint pain for osteoporotic compression fracture: one year retrospective study

Abstract

Objective: To evaluate the outcomes of medial branch block in facet joint pain for osteoporotic compression fracture and utilize multiple regression, the relationship between their impact on treatment outcome and other factor, such as the radiologic finding, clinical parameters was analyze.

Methods: Fifty-three patients with axial back pain from osteoporotic compression fracture were enrolled. The clinical outcomes were measured by Verbal Numeric Rating Scale (VNS) and Oswestry Disability Index (ODI) before treatment, 2 weeks, 3 months, and 12 months after the medial branch block. Radiographic analysis included measurement of overall sagittal alignment, collapsed vertebral height, and vertebral kyphotic angle. After 12 months, patients' satisfaction was classified to five categories: excellent, good, fair, poor or fail. Statistical analysis of both radiographic and clinical parameters along with treatment outcome was performed to determine any significant correlations between the two.

Results: VNS and ODI was improved 2 weeks after the injection and continued to improve until 12 months. Significant improvement with significant pain relief (>40%), functional improvement (>20%), and the patients rated their satisfaction level as "excellent" or "good" at 12 months after the first injection were observed in 78.9%. The radiographic and clinical parameters were not significantly correlated with treatment outcome.

Conclusion: Our retrospective study demonstrated that the medial branch block provided significant pain relief and functional recovery to the patients with osteoporotic spinal compression fractures complaining of continuous facet joint pain after vertebroplasty or conservative treatment. A placebo-controlled prospective randomized double-blind study should be conducted in the future to evaluate the treatment effects.

Keywords: Compression fractures; Osteoporotic fractures; Spinal injections.

Fig. 1

T11, T12 medial branch block in patient with L1 compression fracture (vertebroplasty state). The T12-L1 joint is the medial branch of the T11 and T12 dorsal ramus. Anteroposterior radiography of contrast medium injected onto the target point for T11 and T12 medial branch blocks. The needle tip point to the contrast medium at the site for T11 and T12 medial branch blocks on the T12 and L1 superior articular processes. P, pedicle.

Fig. 2

The sagittal kyphotic angle of local segment was obtained by measuring the acute angle between the upper vertebral upper margin and lower vertebral lower margin of the collapsed vertebral body. β, measurement of the local kyphosis.