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23rd Annual Pain Medicine Meeting 2024
November 21-23, 2024 | Caesars Palace, Las Vegas, Nevada
6235
THERAPEUTIC UTILIZATION OF MEDIAL BRANCH BLOCK AFTER LUMBAR VERTEBRAL COMPRESSION FRACTURE: A RETROSPECTIVE OUTCOMES REVIEW
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Scientific Abstracts > Chronic Pain
Therapeutic Utilization Of Medial Branch Block After Lumbar Vertebral Compression Fracture: A Retrospective Outcomes Review
Maria Cecilia Guerrero, DO1, Anthony Reyes, MD2, Bhargavi Madhu, DO1, Francesco Maoli, MD2, Shiva Nuti3, Anusha Pasupuleti, MD1, Roshan Santhosh, DO1
1 Department of Physical Medicine & Rehabilitation, Larkin Community Hospital, South Miami, Florida
2 Department of Physical Medicine & Rehabilitation, Rush University Medical Center, Chicago, Illinois 3 John Sealy School of Medicine at The University of Texas Medical Branch, Galveston, Texas
INTRO
● With the aging population, the incidence of vertebral compression fractures (VCFs) rose to 8.6 million cases globally in 2019, resulting in long-term pain, functional decline, and increased morbidity and mortality
● Medial branch blocks (MBBs) can provide significant pain relief for refractory axial back pain post vertebral augmentation (VA), likely from the mitigation of pain from increased posterior mechanical load on facet joints due to vertebral height loss.
● MBBs may have utility in the early management of acute VCF to improve pain control
METHODS
● Propensity score matched case-control study using TriNetX, a federated open-source database housing de-identified patient data
● Query: 3 month outcomes in patients who received lumbar MBBs within 6 weeks of a lumbar VCF vs those treated with standard of care
● 2,265 patients in each cohort post propensity score matching
● Primary outcomes investigated included all-cause mortality, rates of kyphoplasty, utilization of opioids, rates of acute falls, and utilization of osteoporosis treatments such as bisphosphonates and denosumab
RESULTS
Patients who received a Medial Branch Block within 6 weeks following VCF had a 67% lower all-cause mortality and 57.5% lower kyphoplasty rates when matched for age, race, gender, and various comorbid conditions
DISCUSSION
● Our analysis reveals low utilization rates of osteoporosis treatments among both cohorts, highlighting a gap in comprehensive management
● MBBs were associated with improved pain control, lower rates of falls, reduced opioid utilization, lower mortality, and lower rates of VA in this analysis
● These preliminary findings suggest that future RCTs should investigate the clinical utility of early MBB in patients with stableVCF
● Comparable rates of risk reduction in mortality, kyphoplasty, and falls were noted in a similar analysis observing 12 month outcomes with the same cohort
● Although VA procedures have good safety profiles and strong clinical efficacy, we should critically evaluate whether there may be a role for MBB in the acute management of VCF