Analysis of balance in adults with chronic axial spinal pain receiving medial branch block or radiofrequency ablation procedures.

BACKGROUND

Medial branch blocks (MBB) and radiofrequency ablations (RFA) are common diagnostic, prognostic, and interventional procedures performed for the management of cervical and lumbar spine facetogenic pain. Although these procedures have established utility as pain management strategies, it is unclear if the disruption in function of the medial branch nerve leads to patient balance impairment.

OBJECTIVE

(1) To determine if there was a difference in postural balance, measured using a head mountable physiological vibration acceleration (Phybrata) sensor, between those pursuing cervical or lumbar MBBs/RFAs compared to an asymptomatic healthy cohort (HC). (2) To determine differences in balance and sensory reweighting prior to and following MBBs/RFAs, and the association with clinical measures of pain and balance using the 4-Stage Balance Test.

DESIGN

Quasiexperimental study with matched controls.

SETTING

Community multidisciplinary chronic musculoskeletal pain practice.

PARTICIPANTS

Sixty individuals with chronic axial back pain and 60 age-/gender-matched healthy individuals.

INTERVENTIONS/MAIN OUTCOME MEASURES: Standing balance measures recorded with the Phybrata sensor, subjective report of pain (numerical rating scale), and clinical measures of balance (4-Stage Balance Test) were analyzed before and after participants underwent MBBs/RFAs and compared to an asymptomatic HC.

RESULTS

Participants with axial spinal pain of facet joint origin (≥ 50% relief post MBB/RFA) demonstrated balance degradation when standing with eyes closed, when compared to participants with nonspecific axial spinal pain (< 50% pain relief) or HCs - both prior to and following MBBs/RFAs. Following MBBs/RFAs, participants undergoing C2/3 procedures demonstrated increased postural sway. The remainder of participants with axial spinal pain did not show any further balance deficits, with corresponding sensory reweighting adaptation. Phybrata measures were not associated with pain location or pain intensity prior to or after MBBs/RFAs.

CONCLUSIONS

These results suggest the risk of developing significant balance impairments following MBB/RFA procedure of either the cervical (excluding C2/3) or lumbar spine is low, although residual balance deficits remain.