Radiofrequency Neurotomy of the Gray Ramus Communicans for Lumbar Osteoporotic Compression Fracture

OBJECTIVE: The aim of this study was to determine the efficacy of percutaneous radiofrequency neurotomy(RFN) of grayramus communicans nerve in patients suffering from severe low back pain due to osteoporotic compression fracture. METHODS: Twenty two patients with lumbar osteoporotic compression fracture who had intractable back pain for less than two weeks and were performed with RFN at L1-L4 from May 2004 to December 2005 were retrospectively analyzed. Clinical outcome using visual analogue scale(VAS) pain scores and modified MacNab's grade was tabulated. Complications related to the procedure were assessed. RESULTS: Twenty-two female patients (age from 63 to 81 years old) were included in this study. The mean VAS score prior to RFN was 7.8, it improved to 2.6 within postoperative time of 48 hours, and the mean VAS score after 3 months was 2.8, which was significantly decreased. Eighteen of 22 patients were graded as excellent and good according to modified MacNab's criteria at final follow up. All patients recovered uneventfully, and the neurologic examination revealed no deficits. Two patients showing poor results worsened in symptom. Percutaneous was performed eventually resulting in symptom improvement. There were no significant complications related to the procedure such as sensory dysesthesia, numbness or permanent motor weakness. CONCLUSION: RFN is safe and effective in treating the painful osteoporotic compression fracture. In patients with intractable back pain due to lumbar osteoporotic compression fracture, RFN of gray ramus communicans nerve should be considered as a treatment option prior to vertebroplasty.

Gray Ramus Communicans Nerve Block: A Useful Therapeutic Adjuvant for Painful Osteoporotic Vertebral Compression Fracture

OBJECTIVE: There are limited treatment options for patients with painful osteoporotic vertebral compression fracture(OVCF) in whom surgery is not strongly indicated or when pain persists even after vertebroplasty. Conservative treatments generally do not provide adequate or prolonged pain relief since the pain in these patients is thought to originate from within and surrounding vertebra. The purpose of this study is to verify the usefulness of percutaneous nerve block on gray ramus communicans in these patients. METHODS: We retrospectively analyzed 36 patients in whom nerve blocks on gray ramus communicans were performed for painful OVCF after failure of conservative therapy and/or after percutaneous vertebroplasty. Bilateral nerve blocks were done on the gray ramus tracts of the somatic nerve roots corresponding with OVCF under C-arm fluoroscopic guidance. Patient-reported pain scores and amount of analgesic medication were measured. RESULTS: All patients tolerated procedures well. Significant initial pain relief was noted in 34 (94.4%) patients and the pain relief was durable in 30(88.2%) of these 34 patients at last visit (at least 4 months after procedure). None of these patients required surgeries during the follow-up period. Decreased analgesic requirement was documented in 30(83.3%) of patients. There was no procedure related complication. CONCLUSION: Prompt and relatively prolonged improvement of pain without complication after this procedure in majority of patients with persistently painful OVCF supports its effectiveness and safety. Thus, it may be considered a useful adjuvant therapeutic option in these clinical settings.