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. 2025 Dec 2:18:6463-6475.
doi: 10.2147/JPR.S537937. eCollection 2025.

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 Copenhaver  1
Affiliations

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 et al. J Pain Res. .

Abstract

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.

Keywords: back pain; osteoporosis; radiofrequency ablation; vertebral compression fracture.

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Conflict of interest statement

All of the authors have no conflicts of interests or disclosures. Yunyi Ren and Machelle Wilson received support through the National Center for Advancing Translational Sciences, National Institutes of Health, through grant number UL1 TR001860. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Dr Frank Willard reports personal fees from Boston Scientific, outside the submitted work. Preliminary findings and portions of this abstract were presented as a poster presentation at the University of California, Davis 2023 Annual Medical Student Research Forum. The poster, which included interim results, is available through eScholarship Open Access Publications at the following link: https://escholarship.org/uc/item/6jc5b3fw.

Figures

Figure 1
Figure 1
Posterior view of a facet joint capsule. The inferior articular process (IAP) approaches the joint from above and medially, while the superior articular process (SAP) enters from below and laterally. The joint capsule primarily consists of horizontal collagen fiber bundles. (Image reproduced with permission from the Carreiro/Willard collection.).
Figure 2
Figure 2
Illustration of stress and injury to posterior arch elements following vertebral body collapse. (A) Stylized lateral view of three lumbar vertebrae, with pale gray shading representing the normal contour of the facet joint capsule. (B) Depiction of a middle vertebral body collapse with symmetric vertical fracture, causing downward displacement of the IAP and lamina onto the SAP of the subjacent vertebra. This displacement stretches and inflames the joint capsule (indicated in pale red), with potential pseudoarthrosis formation between the SAP and lamina of the compressed vertebra. (C) Illustration of a wedge fracture of the middle vertebral body, characterized by anterior border collapse exceeding posterior border collapse. The resulting kyphotic angulation drives the IAP of the superior vertebra forward onto the SAP of the collapsed vertebra, leading to facet joint capsule inflammation (indicated in pale red) and/or pseudoarthrosis formation.
Figure 3
Figure 3
Vertebral body fractures. (A) Sagittal section of the vertebral column in an 84-year-old female, showing two adjacent wedge fractures of the T5 and T6 vertebral bodies. The anterior wall of the vertebral body collapses downward, tipping the vertebral column forward on the lower vertebrae creating a kyphotic configuration. (B) Sagittal section of the vertebral column of an 83-year-old male demonstrating collapsed vertebral bodies at L1 and T11. The entire body collapses downward on a vertical axis, decreasing the distance between the surrounding vertebrae.
Figure 4
Figure 4
Heatmap of Percent of Pain Relief by Duration of Pain Relief.
Figure 5
Figure 5
Scatter Plot of Pre-Disability Index versus Percentage of Pain Relief.
See this image and copyright information in PMC

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