Radiofrequency Ablation: Treatment for Posterior Element Pain From Vertebral Compression Fractures

NCT ID: NCT03651804

Last Updated: 2025-07-16

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

WITHDRAWN

Clinical Phase

PHASE4

Study Classification

INTERVENTIONAL

Study Start Date

2019-04-10

Study Completion Date

2023-12-19

Brief Summary

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The purpose of this study is to test the efficacy of radiofrequency ablation of the medial branch nerves (RFA-MBN) in relieving pain and improving physical function in patients with subacute and chronic vertebral compression fractures (VCF).

Detailed Description

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The study examines a novel approach to treat pain associated with VCFs. The usual care therapy currently involves utilizing physical therapy, non-steroidal anti-inflammatory medications, opioids, and bone re-building medications known as bisphosphonates. A usual treatment plan may include some, if not all the above. There is growing evidence that the posterior spinal elements contribute to pain that patients with VCFs experience. RFA-MBN, which targets these posterior spinal elements, may provide more sustained pain relief and improved physical function compared to usual care for these fractures. The procedure essentially "ablates with heat" the medial branch nerves which send pain signals from the posterior elements to the brain.

Patients will be randomly selected into one of two groups. The treatment group will receive the RFA-MBN procedure along with usual care therapy. The control group will undergo usual care. The control group will have the option to cross over to receive RFA-MBN at a defined interval during the study. There will be follow up visits at various intervals to compare pain relief and function based on various surveys of the treatment, control, and cross-over groups.

Conditions

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Vertebral Compression Fracture Facet Joint Pain

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Control Group

The control group will receive usual care for treatment of vertebral compression fractures, which will consist of but not limited to: physical therapy, opioids, NSAIDs, acetaminophen and bisphosphonates as indicated. They will have the option of crossing over (see "Crossover Group") at twelve weeks.

Group Type ACTIVE_COMPARATOR

Non-steroidal anti-inflammatory drugs

Intervention Type DRUG

Some of the most commonly used pain medicines in adults. NSAIDs block proteins, called enzymes, in the body that play a role in pain and inflammation. They include aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), and many other generic and brand name drugs.

Bisphosphonates

Intervention Type DRUG

A class of drugs that prevent the loss of bone density and are used to treat osteoporosis and similar diseases.

Acetaminophen

Intervention Type DRUG

A medicine used to treat pain and fever. It is typically used for mild to moderate pain relief. Commonly known as Tylenol.

Physical therapy

Intervention Type BEHAVIORAL

Physical Therapy.

Opioids

Intervention Type DRUG

Opioids are narcotics that act on opioid receptors to produce morphine-like effects and medically they are primarily used for pain relief.

Treatment Group

The treatment group will receive usual care for treatment and the treatment procedure comprised of the Medial Branch Block and Radiofrequency Ablation. In cases where a medial branch nerve block has confirmed there is pain relief, a radiofrequency ablation is considered. These patients will continue their usual care therapy as well.

Group Type ACTIVE_COMPARATOR

Radiofrequency ablation of the medial branch nerves

Intervention Type PROCEDURE

A radiofrequency ablation (RFA) is a procedure in which a heat lesion via a needle is created on the nerve that transmits the pain signal in order to interrupt the brain to interrupt the painful signal to the brain. We will target the medial branch nerves.

Non-steroidal anti-inflammatory drugs

Intervention Type DRUG

Some of the most commonly used pain medicines in adults. NSAIDs block proteins, called enzymes, in the body that play a role in pain and inflammation. They include aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), and many other generic and brand name drugs.

Bisphosphonates

Intervention Type DRUG

A class of drugs that prevent the loss of bone density and are used to treat osteoporosis and similar diseases.

Acetaminophen

Intervention Type DRUG

A medicine used to treat pain and fever. It is typically used for mild to moderate pain relief. Commonly known as Tylenol.

Physical therapy

Intervention Type BEHAVIORAL

Physical Therapy.

Opioids

Intervention Type DRUG

Opioids are narcotics that act on opioid receptors to produce morphine-like effects and medically they are primarily used for pain relief.

Crossover Group

This group will comprise of patients within the control group who after 12 weeks of usual therapy will have the option of crossing over to the treatment group. Once crossed over, their treatment and course and measurements will be identical to that of the treatment group.

Group Type ACTIVE_COMPARATOR

Radiofrequency ablation of the medial branch nerves

Intervention Type PROCEDURE

A radiofrequency ablation (RFA) is a procedure in which a heat lesion via a needle is created on the nerve that transmits the pain signal in order to interrupt the brain to interrupt the painful signal to the brain. We will target the medial branch nerves.

Non-steroidal anti-inflammatory drugs

Intervention Type DRUG

Some of the most commonly used pain medicines in adults. NSAIDs block proteins, called enzymes, in the body that play a role in pain and inflammation. They include aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), and many other generic and brand name drugs.

Bisphosphonates

Intervention Type DRUG

A class of drugs that prevent the loss of bone density and are used to treat osteoporosis and similar diseases.

Acetaminophen

Intervention Type DRUG

A medicine used to treat pain and fever. It is typically used for mild to moderate pain relief. Commonly known as Tylenol.

Physical therapy

Intervention Type BEHAVIORAL

Physical Therapy.

Opioids

Intervention Type DRUG

Opioids are narcotics that act on opioid receptors to produce morphine-like effects and medically they are primarily used for pain relief.

Interventions

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Radiofrequency ablation of the medial branch nerves

A radiofrequency ablation (RFA) is a procedure in which a heat lesion via a needle is created on the nerve that transmits the pain signal in order to interrupt the brain to interrupt the painful signal to the brain. We will target the medial branch nerves.

Intervention Type PROCEDURE

Non-steroidal anti-inflammatory drugs

Some of the most commonly used pain medicines in adults. NSAIDs block proteins, called enzymes, in the body that play a role in pain and inflammation. They include aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), and many other generic and brand name drugs.

Intervention Type DRUG

Bisphosphonates

A class of drugs that prevent the loss of bone density and are used to treat osteoporosis and similar diseases.

Intervention Type DRUG

Acetaminophen

A medicine used to treat pain and fever. It is typically used for mild to moderate pain relief. Commonly known as Tylenol.

Intervention Type DRUG

Physical therapy

Physical Therapy.

Intervention Type BEHAVIORAL

Opioids

Opioids are narcotics that act on opioid receptors to produce morphine-like effects and medically they are primarily used for pain relief.

Intervention Type DRUG

Other Intervention Names

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RFA-MBB NSAID Tylenol

Eligibility Criteria

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Inclusion Criteria

* 18-90 years old
* Male or female
* Age of fracture greater than or equal to 6 weeks
* Single Level Vertebral Compression Fracture
* Vertebral compression fracture Thoraic-9 to Lumbar-5
* NRS \>6/10

• Exclusion
* \<18 or \>90 yo
* Uncorrectable Coagulopathy
* Multiple Level Vertebral Compression Fractures
* Surgery within 60 days of presentation
* Active infection
* Rhuematologic disease
* Significant neurologic deficit
* Radicular pain
* Chronic low back pain in last year
* Inability to give consent
* Cognitive impairment
* Patients with Ongoing Litigation or Worker's Compensation Cases
Minimum Eligible Age

18 Years

Maximum Eligible Age

90 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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University of California, Davis

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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David Copenhaver, MD

Role: PRINCIPAL_INVESTIGATOR

UC Davis Medical Center, Department of Anesthesiology and Pain Medicine

Locations

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UC Davis Medical Center

Davis, California, United States

Site Status

Countries

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United States

References

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Boonen S, Van Meirhaeghe J, Bastian L, Cummings SR, Ranstam J, Tillman JB, Eastell R, Talmadge K, Wardlaw D. Balloon kyphoplasty for the treatment of acute vertebral compression fractures: 2-year results from a randomized trial. J Bone Miner Res. 2011 Jul;26(7):1627-37. doi: 10.1002/jbmr.364.

Reference Type BACKGROUND
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Wardlaw D, Cummings SR, Van Meirhaeghe J, Bastian L, Tillman JB, Ranstam J, Eastell R, Shabe P, Talmadge K, Boonen S. Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (FREE): a randomised controlled trial. Lancet. 2009 Mar 21;373(9668):1016-24. doi: 10.1016/S0140-6736(09)60010-6. Epub 2009 Feb 24.

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Klazen CA, Lohle PN, de Vries J, Jansen FH, Tielbeek AV, Blonk MC, Venmans A, van Rooij WJ, Schoemaker MC, Juttmann JR, Lo TH, Verhaar HJ, van der Graaf Y, van Everdingen KJ, Muller AF, Elgersma OE, Halkema DR, Fransen H, Janssens X, Buskens E, Mali WP. Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial. Lancet. 2010 Sep 25;376(9746):1085-92. doi: 10.1016/S0140-6736(10)60954-3. Epub 2010 Aug 9.

Reference Type BACKGROUND
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Kallmes DF, Comstock BA, Heagerty PJ, Turner JA, Wilson DJ, Diamond TH, Edwards R, Gray LA, Stout L, Owen S, Hollingworth W, Ghdoke B, Annesley-Williams DJ, Ralston SH, Jarvik JG. A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med. 2009 Aug 6;361(6):569-79. doi: 10.1056/NEJMoa0900563.

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Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006 Dec;17(12):1726-33. doi: 10.1007/s00198-006-0172-4. Epub 2006 Sep 16.

Reference Type BACKGROUND
PMID: 16983459 (View on PubMed)

Solberg J, Copenhaver D, Fishman SM. Medial branch nerve block and ablation as a novel approach to pain related to vertebral compression fracture. Curr Opin Anaesthesiol. 2016 Oct;29(5):596-9. doi: 10.1097/ACO.0000000000000375.

Reference Type BACKGROUND
PMID: 27548307 (View on PubMed)

Bogduk N, MacVicar J, Borowczyk J. The pain of vertebral compression fractures can arise in the posterior elements. Pain Med. 2010 Nov;11(11):1666-73. doi: 10.1111/j.1526-4637.2010.00963.x.

Reference Type BACKGROUND
PMID: 21044256 (View on PubMed)

Kim TK, Kim KH, Kim CH, Shin SW, Kwon JY, Kim HK, Baik SW. Percutaneous vertebroplasty and facet joint block. J Korean Med Sci. 2005 Dec;20(6):1023-8. doi: 10.3346/jkms.2005.20.6.1023.

Reference Type BACKGROUND
PMID: 16361816 (View on PubMed)

Park KD, Jee H, Nam HS, Cho SK, Kim HS, Park Y, Lim OK. Effect of medial branch block in chronic facet joint pain for osteoporotic compression fracture: one year retrospective study. Ann Rehabil Med. 2013 Apr;37(2):191-201. doi: 10.5535/arm.2013.37.2.191. Epub 2013 Apr 30.

Reference Type BACKGROUND
PMID: 23705113 (View on PubMed)

Im TS, Lee JW, Lee E, Kang Y, Ahn JM, Kang HS. Effects of Facet Joint Injection Reducing the Need for Percutaneous Vertebroplasty in Vertebral Compression Fractures. Cardiovasc Intervent Radiol. 2016 May;39(5):740-745. doi: 10.1007/s00270-015-1286-x. Epub 2015 Dec 29.

Reference Type BACKGROUND
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Mitra R, Do H, Alamin T, Cheng I. Facet pain in thoracic compression fractures. Pain Med. 2010 Nov;11(11):1674-7. doi: 10.1111/j.1526-4637.2010.00953.x. Epub 2010 Oct 1.

Reference Type BACKGROUND
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Wang B, Guo H, Yuan L, Huang D, Zhang H, Hao D. A prospective randomized controlled study comparing the pain relief in patients with osteoporotic vertebral compression fractures with the use of vertebroplasty or facet blocking. Eur Spine J. 2016 Nov;25(11):3486-3494. doi: 10.1007/s00586-016-4425-4. Epub 2016 Feb 5.

Reference Type BACKGROUND
PMID: 26850264 (View on PubMed)

Lord SM, Barnsley L, Wallis BJ, McDonald GJ, Bogduk N. Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain. N Engl J Med. 1996 Dec 5;335(23):1721-6. doi: 10.1056/NEJM199612053352302.

Reference Type BACKGROUND
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Huskisson EC. Measurement of pain. Lancet. 1974 Nov 9;2(7889):1127-31. doi: 10.1016/s0140-6736(74)90884-8. No abstract available.

Reference Type BACKGROUND
PMID: 4139420 (View on PubMed)

Related Links

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Other Identifiers

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1198963

Identifier Type: -

Identifier Source: org_study_id

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