Efficacy of Medial Branch Blocks for Pain Control and Functionality in Pediatric Patients with Spinal Pain

Purpose: While medial branch blocks (MBB) are relatively common for pain relief in adults with spinal pain, they are rarely performed on children. To our knowledge, this is the largest study examining the effectiveness and safety of using MBB as an intervention for spinal pain in pediatrics. Methods: A retrospective chart review was conducted on a population of pediatric patients who underwent MBB at Cook Children's Medical Center between June 1, 2012 and May 31, 2019. Demographics, diagnoses, overall functional improvement, complications, and pre-/post-intervention pain scores on 0-10-point scales were reviewed. Only the first MBB was analyzed. Patients missing a pain score or lost to follow-up were excluded from analyses. Change in pain scores was assessed with Wilcoxon's signed-rank test. Results: There were 52 patients (39 females; 42 white; median age 15.84 years, range 9.36-18.86) with a total of 66 MBB; 17 patients had repeat interventions. Common diagnoses included back pain (48%), spondylolysis (31%), lumbago (29%), and facet pain (23%). Pain scores improved for 87% of patients, 12% were unchanged, and 2% worsened. The pain score change was statistically significant (median= -4.5, range= -9 to 5, p< 0.0001). Post-intervention, 81% of patients had overall improvement in functionality. Procedural complications (e.g., weakness, numbness) occurred in 12% of patients; side effects (e.g., muscle spasms, bruising) occurred in 12% of patients. Conclusions: These results suggest that MBB may improve pain and function in pediatric patients with spinal pain.