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

ABSTRACT

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.