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. 2021 Jul 23;57(8):744.
doi: 10.3390/medicina57080744.

Gray Ramus Communicans Nerve Block for Acute Pain Control in Vertebral Compression Fracture

Dou-Young Park  1 , Il Choi  1 , Tae-Gyum Kim  2 , Woo-Jae Kim  3 , Il-Young Shin  1 , Eun-Kyung Khil  4
Affiliations

Gray Ramus Communicans Nerve Block for Acute Pain Control in Vertebral Compression Fracture

Dou-Young Park et al. Medicina (Kaunas). .

Abstract

Background and Objectives: The current options for acute pain control of vertebral compression fracture include hard brace, vertebroplasty, early surgery, and analgesic injection. We hypothesize that the gray ramus communicans nerve block (GRNB) controls the acute pain experienced during vertebral compression fractures. This study assessed the time course of pain control after injection and evaluated the risk factors affecting pain control failure. Materials and methods: Sixty-three patients (24 male, 66.19 ± 15.17 y) with a thoracolumbar vertebral fracture at the T10-L5 spine, who presented to our hospital from November 2018 to October 2019, were included in this retrospective cohort study. GRNB was performed within 1 week of the trauma. The patients were followed up on days 3, 14, 30, 90, and 180 and assessed with the serial visual analog scale (VAS, resting and motion), Oswestry Low Back Disability (ODI) questionnaire, and Roland-Morris Disability Questionnaire (RDQ). The failure group was defined by the need for an additional block or cement injection after a single GRNB. The failure group's risk factors, such as body mass index, initial thoracolumbar injury classification and severity score, Kummel's disease, age, bone marrow density (BMD), and underlying disease, were analyzed. Results: The motion VAS score improved from preoperative to three months post-procedure, but the resting VAS was affected by the procedure for only three days. The quality of life index improved at postoperative six months. A lower BMD was the only risk that affected treatment failure in the logistic regression analysis (p = 0.0038). Conclusion: The effect of GRNB was maintained even at three months after trauma based on motion VAS results. The only risk factor identified for GRNB failure was lower BMD.

Keywords: Oswestry Low Back Disability Questionnaire; Roland–Morris Disability Questionnaire; bone marrow density; compression fracture; osteoporosis; serial visual analog scale.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Flow chart of numbers of participants at each stage of study divided into a success group and a failure group. Computer Tomography (CT); Magnetic resonance imaging (MRI); visual analog scale (VAS); gray ramus communicans nerve block (GRNB).
Figure 2
Figure 2
Gray ramus communicans nerve block procedures under the fluoroscopy. Anteroposterior (A) and lateral (B) fluoroscopic pictures show that it was confirmed through contrast media and images that the tip of the spinal needle is at the position of the gray ramus communicans.
Figure 3
Figure 3
Illustration of gray ramus nerve block procedure: (A) axial view, (B) sagittal view, (C) the setting and position of patient and fluoroscopy for gray ramus communicans nerve block.
See this image and copyright information in PMC

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