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Qi LN, Sun Y, Shi YT, Yang JH, Yang YR, Qin XZ. Comparison of the Efficacy of Different Radiofrequency Techniques for the Treatment of Lumbar Facet Joint Pain: Combined with Anatomy. Curr Pain Headache Rep 2024; 28:699-708. [PMID: 38526650 DOI: 10.1007/s11916-024-01241-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE OF REVIEW Lumbar facet pain is generally considered to be one of the major causes of chronic low back pain. Each lumbar facet joint is innervated by the medial branch of the posterior spinal nerve from its own level and above. Radiofrequency (RF) of the medial branch of the posterior branch of the spinal nerve is an effective method for the treatment of lumbar facet pain. RF technology is diverse, including traditional radiofrequency (TRF), pulsed radiofrequency (PRF), cooled radiofrequency (CRF), low-temperature plasma radiofrequency ablation (CA), and other treatment methods. The purpose of this paper is to compare the efficacy of different radiofrequency techniques and to analyze the reasons for this in the context of anatomy. RECENT FINDINGS There have been studies confirming the differences in efficacy of different RF techniques. However, most of the studies only compared two RF techniques, not four techniques, TRF, CRF, PRF, and CA, and did not analyze the reasons for the differences in efficacy. This article reviews the differences in the efficacy of the above four RF techniques, clarifies that the differences are mainly due to the inability to precisely localize the medial branch of the posterior branch of the spinal nerve, analyzes the reasons for the inability to precisely localize the posterior branch of the spinal nerve in conjunction with anatomy, and proposes that the development of RF technology for lumbar facet pain requires more in-depth anatomical, imaging, and clinical studies.
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Affiliation(s)
- Ling Na Qi
- Medical College of Yanbian University, No. 977 Gong Yuan Road, Yanji, Jilin Province, China
| | - Ye Sun
- Medical College of Yanbian University, No. 977 Gong Yuan Road, Yanji, Jilin Province, China
| | - Yu Tong Shi
- Medical College of Yanbian University, No. 977 Gong Yuan Road, Yanji, Jilin Province, China
| | - Jing Han Yang
- Medical College of Yanbian University, No. 977 Gong Yuan Road, Yanji, Jilin Province, China
| | - Yi Ran Yang
- Medical College of Yanbian University, No. 977 Gong Yuan Road, Yanji, Jilin Province, China
| | - Xiang Zheng Qin
- Department of Anatomy, Medical College of Yanbian University, Yanji, Jilin Province, China.
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Van den Heuvel SAS, Cohen SPC, de Andrès Ares J, Van Boxem K, Kallewaard JW, Van Zundert J. 3. Pain originating from the lumbar facet joints. Pain Pract 2024; 24:160-176. [PMID: 37640913 DOI: 10.1111/papr.13287] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 07/19/2023] [Accepted: 08/04/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Pain originating from the lumbar facets can be defined as pain that arises from the innervated structures comprising the joint: the subchondral bone, synovium, synovial folds, and joint capsule. Reported prevalence rates range from 4.8% to over 50% among patients with mechanical low back pain, with diagnosis heavily dependent on the criteria employed. In well-designed studies, the prevalence is generally between 10% and 20%, increasing with age. METHODS The literature on the diagnosis and treatment of lumbar facet joint pain was retrieved and summarized. RESULTS There are no pathognomic signs or symptoms of pain originating from the lumbar facet joints. The most common reported symptom is uni- or bilateral (in more advanced cases) axial low back pain, which often radiates into the upper legs in a non-dermatomal distribution. Most patients report an aching type of pain exacerbated by activity, sometimes with morning stiffness. The diagnostic value of abnormal radiologic findings is poor owing to the low specificity. SPECT can accurately identify joint inflammation and has a predictive value for diagnostic lumbar facet injections. After "red flags" are ruled out, conservatives should be considered. In those unresponsive to conservative therapy with symptoms and physical examination suggesting lumbar facet joint pain, a diagnostic/prognostic medial branch block can be performed which remains the most reliable way to select patients for radiofrequency ablation. CONCLUSIONS Well-selected individuals with chronic low back originating from the facet joints may benefit from lumbar medial branch radiofrequency ablation.
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Affiliation(s)
- Sandra A S Van den Heuvel
- Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Steven P C Cohen
- Anesthesiology, Pain Medicine Division, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Koen Van Boxem
- Anesthesiology, Critical Care and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium
- Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jan Willem Kallewaard
- Anesthesiology and Pain Medicine, Rijnstate Ziekenhuis, Velp, The Netherlands
- Anesthesiology and Pain Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Jan Van Zundert
- Anesthesiology, Critical Care and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium
- Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
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Khan SA, Dovgan J, Haring RS, Schneider BJ. Current trends in the technical performance of lumbar zygapophyseal joint interventions. INTERVENTIONAL PAIN MEDICINE 2023; 2:100168. [PMID: 39239598 PMCID: PMC11372996 DOI: 10.1016/j.inpm.2022.100168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/17/2022] [Accepted: 11/27/2022] [Indexed: 09/07/2024]
Abstract
Objective To survey how interventional pain physicians are currently performing lumbar facet interventions, with an emphasis on fellowship training. Design Survey Study. Methods An online electronic survey disseminated via Research Electronic Data Capture (REDCap) software to current and expired attending physician members of the Spine Intervention Society (SIS). Responses were stratified by fellowship training type: ACGME Pain Medicine (APM), ACGME Sports Medicine (ASM), Interventional Spine and Musculoskeletal Medicine (ISMM), or None. Results As a whole, a majority of respondents indicated on independent questions they require 2 diagnostic medial branch blocks (MBBs) performed with 0.5 cc or less of anesthetic to result in at least 75% pain relief before proceeding with a radiofrequency neurotomy (RFN), performed via parallel approach with 18g or larger needle and 10 mm active tip and a lesion of at least 80-85° C and 90-119 s of duration. Statistically significant differences as stratified by APM vs ISMM fellowship training included: the use of corticosteroids at the time of RFN (43/79 (54.4%) vs 16/63 (25.4%), typically treating 3 segments or more 22/79 (27.8%) vs 7/73 (9.6%), and MBB volume injectate of ≥ 1 cc 22/79 (27.8%) vs 7/63 (11.1%) respectively. Conclusions There is largely agreement upon the technical performance of lumbar facet interventions by members of SIS. Physicians who completed an APM fellowship were more likely to report using corticosteroids at the time of RFN, using higher anesthetic volumes and treating 3 or more spinal segments.
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Affiliation(s)
- Samir A Khan
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jakob Dovgan
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
| | - R Sterling Haring
- Department of Anesthesiology, Division of Pain Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Byron J Schneider
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
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Janapala RN, Manchikanti L, Sanapati MR, Thota S, Abd-Elsayed A, Kaye AD, Hirsch JA. Efficacy of Radiofrequency Neurotomy in Chronic Low Back Pain: A Systematic Review and Meta-Analysis. J Pain Res 2021; 14:2859-2891. [PMID: 34531682 PMCID: PMC8439627 DOI: 10.2147/jpr.s323362] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/03/2021] [Indexed: 12/23/2022] Open
Abstract
Purpose The objective of the systematic review and meta-analysis is to evaluate the efficacy of radiofrequency neurotomy as a therapeutic lumbar facet joint intervention. Patients and Methods Utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist, a systematic review and meta-analysis was performed. A comprehensive literature search of multiple data sources from 1966 to September 2020 including manual searches of bibliography of known review articles was performed. The inclusion criteria were based on the selection of patients with chronic low back pain with diagnosis confirmed based on controlled diagnostic blocks and with the publication of at least 6 months of results of appropriate outcome parameters. Quality assessment of the trials was performed with Cochrane review criteria and interventional pain management techniques-quality appraisal of reliability and risk of bias assessment (IPM-QRB). The level of evidence of effectiveness is classified at five levels ranging from Level I to Level V. The primary outcome measure was a significant reduction in pain, eg, short term (up to 6 months) and long term (more than 6 months). The secondary outcome measure was an improvement in functional status. Results A total of 12 randomized controlled trials (RCTs) met the inclusion criteria for evaluating the efficacy of lumbar radiofrequency neurotomy. Radiofrequency neurotomy showed Level II evidence for efficacy for both the short term and long term. Conclusion This systematic review of the assessment of the efficacy of radiofrequency neurotomy in managing chronic low back pain was based on the inclusion of 12 RCTs with a diagnostic block and at least 6 months of follow-up results that showed Level II evidence for both short-term and long-term improvement.
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Affiliation(s)
- Rajesh N Janapala
- School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | - Laxmaiah Manchikanti
- Pain Management Centers of America, Paducah, KY, USA.,Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY, USA.,Department of Anesthesiology, School of Medicine, LSU Health Sciences Center, Shreveport, LA, USA
| | - Mahendra R Sanapati
- Pain Management Centers of America, Evansville, IN, USA.,Anesthesiology and Research, School of Medicine, LSU Health Sciences Center, Shreveport, LA, USA
| | | | - Alaa Abd-Elsayed
- UW Health Pain Services, and Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Alan D Kaye
- Departments of Anesthesiology and Pharmacology, Toxicology, and Neurosciences, LSU Health Sciences Center, Shreveport, LA, USA.,Ochsner Shreveport Hospital and Pain Clinic Feist-Weiller Cancer Center, Shreveport, LA, USA
| | - Joshua A Hirsch
- Neurointerventional Radiology and Spine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Hegmann KT, Travis R, Andersson GBJ, Belcourt RM, Carragee EJ, Eskay-Auerbach M, Galper J, Goertz M, Haldeman S, Hooper PD, Lessenger JE, Mayer T, Mueller KL, Murphy DR, Tellin WG, Thiese MS, Weiss MS, Harris JS. Invasive Treatments for Low Back Disorders. J Occup Environ Med 2021; 63:e215-e241. [PMID: 33769405 DOI: 10.1097/jom.0000000000001983] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This abbreviated version of the American College of Occupational and Environmental Medicine's Low Back Disorders guideline reviews the evidence and recommendations developed for invasive treatments used to manage low back disorders. METHODS Comprehensive systematic literature reviews were accomplished with article abstraction, critiquing, grading, evidence table compilation, and guideline finalization by a multidisciplinary expert panel and extensive peer-review to develop evidence-based guidance. Consensus recommendations were formulated when evidence was lacking and often relied on analogy to other disorders for which evidence exists. A total of 47 high-quality and 321 moderate-quality trials were identified for invasive management of low back disorders. RESULTS Guidance has been developed for the invasive management of acute, subacute, and chronic low back disorders and rehabilitation. This includes 49 specific recommendations. CONCLUSION Quality evidence should guide invasive treatment for all phases of managing low back disorders.
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Affiliation(s)
- Kurt T Hegmann
- American College of Occupational and Environmental Medicine, Elk Grove Village, Illinois
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Aransay ÁLS, Valladares ÁC, Muñoz RC, Parrilla ÁRP, Muñiz IP, Cuello LG, Negreira JM. Prospective analysis of radiofrequency denervation in patients with chronic low back pain. JOURNAL OF SPINE SURGERY (HONG KONG) 2020; 6:703-712. [PMID: 33447672 PMCID: PMC7797797 DOI: 10.21037/jss-20-599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 10/23/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND To analyse the effectiveness of lumbar rhizolysis in patients with facet joint-related chronic low back pain and to study the influence of various variables on the results. Facet joints are thought to be responsible for up to 15% of all cases of chronic low back pain. Although radiofrequency denervation of these joints is a common procedure, there is currently no solid evidence to allow the selection of patients who may be candidates for this technique to be selected or the effectiveness and safety thereof to be demonstrated. METHODS A prospective analytical study of 100 patients treated with lumbar rhizolysis at the Hospital Universitario de Cabueñes (Gijón, Spain) between 2016 and 2019. Various demographic variables, the evolution of the visual analogue scale (VAS), the Oswestry Disability Index (ODI) and consumption of analgesics pre- and postoperatively was analysed at 2, 6, 12 and 24 months. RESULTS The mean age of our sample was 57.8 years (27.0-85.5), with a BMI of 27.09 (16.14-46.22), and 63.8% of subjects were female. The mean duration of the symptoms prior to the intervention was 8.7 years, with 28.7% of subjects having a history of spinal surgery. The intervention resulted in a significant reduction in analgesics consumption. Moreover, a statistically significant reduction in pure low back pain, radiating pain and in the ODI in the short to medium term was observed with respect to baseline. We found that being female, having a history of prior low back surgery, the time to progression and the analgesic level consumed by the patient were related to a greater disability. CONCLUSIONS Lumbar rhizolysis results in a significant reduction in pain and functional disability in patients with chronic low back pain in both the short- and medium-term, and reduces the need for analgesics consumption.
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Affiliation(s)
- Álvaro Los Santos Aransay
- Department of Orthopaedics, Cabueñes Universitary Hospital, Gijón (Asturias, Spain), Los Prados, Gijón, Spain
| | - Álvaro Camblor Valladares
- Department of Orthopaedics, Cabueñes Universitary Hospital, Gijón (Asturias, Spain), Los Prados, Gijón, Spain
| | - Roi Castro Muñoz
- Department of Orthopaedics, Da Costa Hospital, Burela (Galicia, Spain), Rafael Vior, Lugo, Spain
| | - Ángel Ramón Piñera Parrilla
- Department of Orthopaedics, Cabueñes Universitary Hospital, Gijón (Asturias, Spain), Los Prados, Gijón, Spain
| | - Iván Pipa Muñiz
- Department of Orthopaedics, Cabueñes Universitary Hospital, Gijón (Asturias, Spain), Los Prados, Gijón, Spain
| | - Lorien García Cuello
- Department of Orthopaedics, Cabueñes Universitary Hospital, Gijón (Asturias, Spain), Los Prados, Gijón, Spain
| | - Javier Mateo Negreira
- Department of Orthopaedics, Cabueñes Universitary Hospital, Gijón (Asturias, Spain), Los Prados, Gijón, Spain
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Cohen SP, Bhaskar A, Bhatia A, Buvanendran A, Deer T, Garg S, Hooten WM, Hurley RW, Kennedy DJ, McLean BC, Moon JY, Narouze S, Pangarkar S, Provenzano DA, Rauck R, Sitzman BT, Smuck M, van Zundert J, Vorenkamp K, Wallace MS, Zhao Z. Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group. Reg Anesth Pain Med 2020; 45:424-467. [PMID: 32245841 PMCID: PMC7362874 DOI: 10.1136/rapm-2019-101243] [Citation(s) in RCA: 177] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 02/07/2020] [Accepted: 02/11/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The past two decades have witnessed a surge in the use of lumbar facet blocks and radiofrequency ablation (RFA) to treat low back pain (LBP), yet nearly all aspects of the procedures remain controversial. METHODS After approval by the Board of Directors of the American Society of Regional Anesthesia and Pain Medicine, letters were sent to a dozen pain societies, as well as representatives from the US Departments of Veterans Affairs and Defense. A steering committee was convened to select preliminary questions, which were revised by the full committee. Questions were assigned to 4-5 person modules, who worked with the Subcommittee Lead and Committee Chair on preliminary versions, which were sent to the full committee. We used a modified Delphi method, whereby the questions were sent to the committee en bloc and comments were returned in a non-blinded fashion to the Chair, who incorporated the comments and sent out revised versions until consensus was reached. RESULTS 17 questions were selected for guideline development, with 100% consensus achieved by committee members on all topics. All societies except for one approved every recommendation, with one society dissenting on two questions (number of blocks and cut-off for a positive block before RFA), but approving the document. Specific questions that were addressed included the value of history and physical examination in selecting patients for blocks, the value of imaging in patient selection, whether conservative treatment should be used before injections, whether imaging is necessary for block performance, the diagnostic and prognostic value of medial branch blocks (MBB) and intra-articular (IA) injections, the effects of sedation and injectate volume on validity, whether facet blocks have therapeutic value, what the ideal cut-off value is for a prognostic block, how many blocks should be performed before RFA, how electrodes should be oriented, the evidence for larger lesions, whether stimulation should be used before RFA, ways to mitigate complications, if different standards should be applied to clinical practice and clinical trials and the evidence for repeating RFA (see table 12 for summary). CONCLUSIONS Lumbar medial branch RFA may provide benefit to well-selected individuals, with MBB being more predictive than IA injections. More stringent selection criteria are likely to improve denervation outcomes, but at the expense of more false-negatives. Clinical trials should be tailored based on objectives, and selection criteria for some may be more stringent than what is ideal in clinical practice.
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Affiliation(s)
- Steven P Cohen
- Anesthesiology, Pain Medicine Division, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Arun Bhaskar
- Anesthesiology, Imperial College Healthcare NHS Trust Haemodialysis Clinic Hayes Satellite Unit, Hayes, UK
| | - Anuj Bhatia
- Anesthesia and Pain Management, University of Toronto and University Health Network-Toronto Western Hospital, Toronto, Ontario, Canada
| | | | - Tim Deer
- Spine & Nerve Centers, Charleston, West Virginia, USA
| | - Shuchita Garg
- Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | - Robert W Hurley
- Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - David J Kennedy
- Physical Medicine & Rehabilitation, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Brian C McLean
- Anesthesiology, Tripler Army Medical Center, Tripler Army Medical Center, Hawaii, USA
| | - Jee Youn Moon
- Dept of Anesthesiology, Seoul National University College of Medicine, Seoul, The Republic of Korea
| | - Samer Narouze
- Center for Pain Medicine, Summa Western Reserve Hospital, Cuyahoga Falls, Ohio, USA
| | - Sanjog Pangarkar
- Dept of Physical Medicine and Rehabilitation, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | | | - Richard Rauck
- Carolinas Pain Institute, Winston Salem, North Carolina, USA
| | | | - Matthew Smuck
- Dept.of Orthopaedic Surgery, Division of Physical Medicine & Rehabilitation, Stanford Medicine, Stanford, California, USA
| | - Jan van Zundert
- Anesthesiology, Critical Care and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Lanaken, Belgium
- Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Mark S Wallace
- Anesthesiology, UCSD Medical Center-Thornton Hospital, San Diego, California, USA
| | - Zirong Zhao
- Neurology, VA Healthcare Center District of Columbia, Washington, District of Columbia, USA
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Schneider BJ, Doan L, Maes MK, Martinez KR, Gonzalez Cota A, Bogduk N. Systematic Review of the Effectiveness of Lumbar Medial Branch Thermal Radiofrequency Neurotomy, Stratified for Diagnostic Methods and Procedural Technique. PAIN MEDICINE 2020; 21:1122-1141. [DOI: 10.1093/pm/pnz349] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abstract
Objective
To determine the effectiveness of lumbar medial branch thermal radiofrequency neurotomy based on different selection criteria and procedural techniques.
Design
Comprehensive systematic review.
Methods
A comprehensive literature search was conducted, and all authors screened and evaluated the studies. The Grades of Recommendation, Assessment, Development, and Evaluation system was used to assess all eligible studies.
Outcome Measures
The primary outcome measure assessed was the success rate of the procedure, defined by varying degrees of pain relief following neurotomy. Data are stratified by number of diagnostic blocks and degree of pain relief, as well as procedural technique with perpendicular or parallel placement of electrodes.
Results
Results varied by selection criteria and procedural technique. At six months, 26% of patients selected via single medial branch block with 50% pain relief and treated via perpendicular technique achieved at least 50% pain relief; 49% of patients selected via dual medial branch blocks with 50% pain relief and treated via parallel technique achieved at least 50% pain relief. The most rigorous patient selection and technique—two diagnostic medial branch blocks with 100% pain relief and parallel electrode placement—resulted in 56% of patients experiencing 100% relief of pain at six months.
Conclusions
This comprehensive systematic review found differences in the effectiveness of lumbar medial branch radiofrequency neurotomy when studies were stratified by patient selection criteria and procedural technique. The best outcomes are achieved when patients are selected based on high degrees of pain relief from dual medial branch blocks with a technique employing parallel electrode placement.
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Affiliation(s)
- Byron J Schneider
- Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, Tennessee
| | - Lisa Doan
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU School of Medicine, New York, New York, USA
| | - Marc K Maes
- Department of Anesthesia, Pain Clinic, A.Z. Jan Portaels, Vilvoorde, Belgium, Rugpoli Brabant/Kliniek, Tilburg, the Netherlands
| | | | | | - Nikolai Bogduk
- Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
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Wolter T, Kleinmann B, Knoeller S. Cryoneurolysis for the treatment of cervical facet joint syndrome: a technical note. J Pain Res 2018; 11:1165-1169. [PMID: 29950888 PMCID: PMC6016535 DOI: 10.2147/jpr.s161053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objective Neck pain has an annual prevalence of 30%. A frequent cause of neck pain is cervical facet joint pain. In cases of refractory cervical facet joint pain, radiofrequency can be employed, but the grade of evidence attested in systematic reviews is fair. Cryoneurolysis has been reported to induce favorable outcomes in lumbar facet joint pain. We sought to examine the feasibility of cervical facet joint cryoneurolysis. Setting Tertiary academic pain center. Patients and methods We report here the operative technique of cervical facet joint cryoneurolysis for patients with cervical facet joint pain. The procedure is performed under CT-guidance. The lesion points are defined with the help of sensory stimulation. Results Six cervical facet joint denervations were carried out in five patients. All patients had an uneventful course with adequate pain relief. Apart from soreness of the paravertebral muscles no severe side effects were encountered. Conclusion This is the first report of cryoneurolysis for the treatment of cervical facet joint pain. The technique is feasible and warrants further studies.
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Affiliation(s)
| | | | - Stefan Knoeller
- Department of Orthopedics and Trauma Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Spine Surgery, Helios Klinik Breisach, Breisach, Germany
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Coles A, Suri P, Rundell S, Nishio I, Shah L, Standaert C, Friedly J. Radiofrequency Ablation for Facet-Mediated Low Back Pain: Current Knowledge and Limitations of the Evidence. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2018. [DOI: 10.1007/s40141-018-0170-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Manchikanti L, Hirsch JA, Falco FJE, Boswell MV. Management of lumbar zygapophysial (facet) joint pain. World J Orthop 2016; 7:315-337. [PMID: 27190760 PMCID: PMC4865722 DOI: 10.5312/wjo.v7.i5.315] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 10/13/2015] [Accepted: 01/29/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the diagnostic validity and therapeutic value of lumbar facet joint interventions in managing chronic low back pain.
METHODS: The review process applied systematic evidence-based assessment methodology of controlled trials of diagnostic validity and randomized controlled trials of therapeutic efficacy. Inclusion criteria encompassed all facet joint interventions performed in a controlled fashion. The pain relief of greater than 50% was the outcome measure for diagnostic accuracy assessment of the controlled studies with ability to perform previously painful movements, whereas, for randomized controlled therapeutic efficacy studies, the primary outcome was significant pain relief and the secondary outcome was a positive change in functional status. For the inclusion of the diagnostic controlled studies, all studies must have utilized either placebo controlled facet joint blocks or comparative local anesthetic blocks. In assessing therapeutic interventions, short-term and long-term reliefs were defined as either up to 6 mo or greater than 6 mo of relief. The literature search was extensive utilizing various types of electronic search media including PubMed from 1966 onwards, Cochrane library, National Guideline Clearinghouse, clinicaltrials.gov, along with other sources including previous systematic reviews, non-indexed journals, and abstracts until March 2015. Each manuscript included in the assessment was assessed for methodologic quality or risk of bias assessment utilizing the Quality Appraisal of Reliability Studies checklist for diagnostic interventions, and Cochrane review criteria and the Interventional Pain Management Techniques - Quality Appraisal of Reliability and Risk of Bias Assessment tool for therapeutic interventions. Evidence based on the review of the systematic assessment of controlled studies was graded utilizing a modified schema of qualitative evidence with best evidence synthesis, variable from level I to level V.
RESULTS: Across all databases, 16 high quality diagnostic accuracy studies were identified. In addition, multiple studies assessed the influence of multiple factors on diagnostic validity. In contrast to diagnostic validity studies, therapeutic efficacy trials were limited to a total of 14 randomized controlled trials, assessing the efficacy of intraarticular injections, facet or zygapophysial joint nerve blocks, and radiofrequency neurotomy of the innervation of the facet joints. The evidence for the diagnostic validity of lumbar facet joint nerve blocks with at least 75% pain relief with ability to perform previously painful movements was level I, based on a range of level I to V derived from a best evidence synthesis. For therapeutic interventions, the evidence was variable from level II to III, with level II evidence for lumbar facet joint nerve blocks and radiofrequency neurotomy for long-term improvement (greater than 6 mo), and level III evidence for lumbosacral zygapophysial joint injections for short-term improvement only.
CONCLUSION: This review provides significant evidence for the diagnostic validity of facet joint nerve blocks, and moderate evidence for therapeutic radiofrequency neurotomy and therapeutic facet joint nerve blocks in managing chronic low back pain.
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12
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Maas ET, Ostelo RWJG, Niemisto L, Jousimaa J, Hurri H, Malmivaara A, van Tulder MW, Cochrane Back and Neck Group. Radiofrequency denervation for chronic low back pain. Cochrane Database Syst Rev 2015; 2015:CD008572. [PMID: 26495910 PMCID: PMC8782593 DOI: 10.1002/14651858.cd008572.pub2] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Radiofrequency (RF) denervation, an invasive treatment for chronic low back pain (CLBP), is used most often for pain suspected to arise from facet joints, sacroiliac (SI) joints or discs. Many (uncontrolled) studies have shown substantial variation in its use between countries and continued uncertainty regarding its effectiveness. OBJECTIVES The objective of this review is to assess the effectiveness of RF denervation procedures for the treatment of patients with CLBP. The current review is an update of the review conducted in 2003. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, three other databases, two clinical trials registries and the reference lists of included studies from inception to May 2014 for randomised controlled trials (RCTs) fulfilling the inclusion criteria. We updated this search in June 2015, but we have not yet incorporated these results. SELECTION CRITERIA We included RCTs of RF denervation for patients with CLBP who had a positive response to a diagnostic block or discography. We applied no language or date restrictions. DATA COLLECTION AND ANALYSIS Pairs of review authors independently selected RCTs, extracted data and assessed risk of bias (RoB) and clinical relevance using standardised forms. We performed meta-analyses with clinically homogeneous studies and assessed the quality of evidence for each outcome using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. MAIN RESULTS In total, we included 23 RCTs (N = 1309), 13 of which (56%) had low RoB. We included both men and women with a mean age of 50.6 years. We assessed the overall quality of the evidence as very low to moderate. Twelve studies examined suspected facet joint pain, five studies disc pain, two studies SI joint pain, two studies radicular CLBP, one study suspected radiating low back pain and one study CLBP with or without suspected radiation. Overall, moderate evidence suggests that facet joint RF denervation has a greater effect on pain compared with placebo over the short term (mean difference (MD) -1.47, 95% confidence interval (CI) -2.28 to -0.67). Low-quality evidence indicates that facet joint RF denervation is more effective than placebo for function over the short term (MD -5.53, 95% CI -8.66 to -2.40) and over the long term (MD -3.70, 95% CI -6.94 to -0.47). Evidence of very low to low quality shows that facet joint RF denervation is more effective for pain than steroid injections over the short (MD -2.23, 95% CI -2.38 to -2.08), intermediate (MD -2.13, 95% CI -3.45 to -0.81), and long term (MD -2.65, 95% CI -3.43 to -1.88). RF denervation used for disc pain produces conflicting results, with no effects for RF denervation compared with placebo over the short and intermediate term, and small effects for RF denervation over the long term for pain relief (MD -1.63, 95% CI -2.58 to -0.68) and improved function (MD -6.75, 95% CI -13.42 to -0.09). Lack of evidence of short-term effectiveness undermines the clinical plausibility of intermediate-term or long-term effectiveness. When RF denervation is used for SI joint pain, low-quality evidence reveals no differences from placebo in effects on pain (MD -2.12, 95% CI -5.45 to 1.21) and function (MD -14.06, 95% CI -30.42 to 2.30) over the short term, and one study shows a small effect on both pain and function over the intermediate term. RF denervation is an invasive procedure that can cause a variety of complications. The quality and size of original studies were inadequate to permit assessment of how often complications occur. AUTHORS' CONCLUSIONS The review authors found no high-quality evidence suggesting that RF denervation provides pain relief for patients with CLBP. Similarly, we identified no convincing evidence to show that this treatment improves function. Overall, the current evidence for RF denervation for CLBP is very low to moderate in quality; high-quality evidence is lacking. High-quality RCTs with larger patient samples are needed, as are data on long-term effects.
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Affiliation(s)
- Esther T Maas
- VU University AmsterdamDepartment of Health Sciences, Faculty of Earth and Life SciencesAmsterdamNetherlands
| | - Raymond WJG Ostelo
- VU University AmsterdamDepartment of Health Sciences, EMGO+ Institute for Health and Care ResearchPO Box 7057AmsterdamNetherlands1007 MB
| | - Leena Niemisto
- Dextra Medical CenterRaumantie 1 aHelsinkiFinlandFIN‐00350
| | | | - Heikki Hurri
- Kuntoutus ORTONRehabilitation CentreTenholantie 10HelsinkiFinlandFIN‐00280
| | - Antti Malmivaara
- National Institute for Health and Welfare (THL)Centre for Health and Social Economics (CHESS)PO Box 30Mannerheimintie 166HelsinkiFinlandFI‐00271
| | - Maurits W van Tulder
- VU University AmsterdamDepartment of Health Sciences, Faculty of Earth and Life SciencesAmsterdamNetherlands
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