Journal CME August 2026: Analysis of balance in adults with chronic axial spinal pain receiving medial branch block or radiofrequency ablation procedures-PM R - 2026 - Carter - Analysis of balance in adults with chronic axial spinal pain receiving medial branch block or (1)

PM R - 2026 - Carter - Analysis of balance in adults with chronic axial spinal pain receiving medial branch block or (1)

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This quasiexperimental study examined whether medial branch blocks (MBBs) and radiofrequency ablations (RFAs), commonly used for cervical and lumbar facet-mediated spinal pain, affect balance. Sixty adults with chronic axial spine pain were compared with 60 age- and sex-matched healthy controls. Balance was measured before and after procedures using a head-mounted accelerometer (Phybrata), the 4-Stage Balance Test, and pain ratings.<br /><br />Key findings:<br />- People with chronic axial spinal pain showed worse balance than healthy controls, especially when standing with eyes closed.<br />- This balance deficit persisted before and after MBB/RFA procedures.<br />- Pain intensity decreased significantly after treatment, and 61% of participants achieved at least 50% pain relief.<br />- However, pain reduction did not correlate with improved balance.<br />- Participants undergoing C2/3 procedures showed increased postural sway after treatment, suggesting this level may have a greater effect on balance than other cervical or lumbar levels.<br />- Most other participants did not show meaningful balance worsening after the procedure, indicating the overall risk of new balance impairment from MBB/RFA is low.<br />- There was a trend toward sensory reweighting after successful treatment, with less reliance on proprioception and more on other balance systems, but this did not reach statistical significance.<br /><br />The authors conclude that MBBs/RFAs generally do not worsen balance in patients with chronic axial spinal pain, except possibly at C2/3. However, baseline balance deficits remain even after pain relief, suggesting that chronic facetogenic pain may cause persistent postural control changes.

Keywords

medial branch blocks

radiofrequency ablation

balance impairment

chronic axial spinal pain

facet-mediated pain

postural sway

cervical spine

lumbar spine

pain relief

sensory reweighting