Gray ramus communicans nerve block: novel treatment approach for painful osteoporotic vertebral compression fracture.
BACKGROUND
Osteoporotic vertebral compression fracture (OVCF) is a common complication of osteoporosis in the aging population. Refractory chronic pain may develop, and few effective treatment options exist.


METHODS
We retrospectively analyzed 52 cases in which gray ramus communicans nerve block was used for painful OVCF after failure of conservative analgesic therapy. All were office-based, fluoroscopically guided procedures; a combination of 2% lidocaine and 2% sterile triamcinolone diacetate (Aristocort) was injected on the gray ramus tract of the somatic nerve root corresponding with radiographically documented OVCF. Patient-reported and physician-reported pain scores, analgesic medication use, and overall patient satisfaction were measured. The average follow-up period was 9 months.


RESULTS
A 1-point improvement in pain scores was reported by 92% of patients and 88% of physicians; a 4-point improvement was reported by 63% and 58%, respectively. No patients reported increased pain scores; physicians reported increases in two cases. Decreased analgesic requirement was documented in 42%. Patient satisfaction was "high" in 50% and "medium" in 25%. No procedural complications occurred.


CONCLUSIONS
Prompt and sustained improvements in all parameters, especially pain scores, support widespread clinical application of this safe effective and cost-effective therapy.
Chandler
G
G
Specialty Clinics of Georgia Research Center, Gainesville 30501, USA.
Dalley
G
G
Hemmer
J
J
Seely
T
T
D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D004338:Drug Combinations; D005260:Female; D005471:Fluoroscopy / Q000379:methods* / Q000523:psychology; D005598:Fractures, Spontaneous / Q000000981:diagnostic imaging / Q000209:etiology* / Q000523:psychology / Q000628:therapy*; D006801:Humans; D007403:Intervertebral Disc / Q000294:innervation*; D008012:Lidocaine; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods* / Q000523:psychology; D010024:Osteoporosis / Q000150:complications* / Q000523:psychology; D010146:Pain / Q000175:diagnosis / Q000209:etiology*; D059408:Pain Management; D010147:Pain Measurement; D017060:Patient Satisfaction; D015641:Radiography, Interventional / Q000379:methods* / Q000523:psychology; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000209:etiology* / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome; D014221:Triamcinolone
D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D004338:Drug Combinations; D014221:Triamcinolone; D008012:Lidocaine