Comparison of Analgesic Therapies in Traumatic Vertebral Compression Fractures: Vertebroplasty and Kyphoplasty vs Thermal Facet Ablation. A Prospective Randomized Trial

Background Vertebral augmentation techniques are common for painful vertebral compression fractures (VCFs). Radiofrequency thermal facet ablation (RFA) is a potential alternative analgesic therapy, but comparative data remains limited. Methods In this single-center, prospective randomized controlled trial, patients with painful VCFs refractory to conservative treatment were randomized to vertebral augmentation or RFA. Pre- and postoperative Visual Analogue Scale (VAS) for axial pain and procedure-related complications were evaluated over a 6-month period. Results Among 535 patients completing follow-up (290 augmentation, 245 RFA), both arms provided robust analgesia. Mean VAS reduction at 6 months was -5.3 (95% CI: -5.6 to -5.0) in the RFA group and -5.6 (95% CI: -5.9 to -5.3) in the augmentation group. The augmentation group had an 8% cement leakage rate (23 cases), with two patients (0.5%) requiring decompression, and a mean length of stay (LOS) of 1.4 days. The RFA arm demonstrated a zero-complication rate and allowed for same-day discharge (LOS 0.0 days). Conclusions RFA and vertebral augmentation are highly effective at providing significant pain relief for VCFs, with comparable reductions in pain scores. With a zero-complication rate and outpatient feasibility, RFA is a safe and resource-efficient first-line alternative to cement-based augmentation. Clinical trial registration ClinicalTrials.gov (Identifier: [Blinded]).