Evaluation of the Short- and Long-Term Effectiveness of Pulsed Radiofrequency and Conventional Radiofrequency Performed for Medial Branch Block in Patients with Lumbar Facet Joint Pain

Abstract

Background Diagnosis of lumbar facet joint disease is the sum of the combinations consisting of history, physical activity, and diagnostic imaging frequently including computed tomography and magnetic resonance imaging scans. Prevalence of facet-based chronic low back pain is 15–45%. Intra-articular injections with corticosteroid or medial branch block are traditionally used prevalently in the management of chronic low back pain due to lumbar facet joints. However, the evidence levels of these procedures are at either a low or a medium level. Radiofrequency neurolysis of the lumbar medial branch can be used as an alternative in the management of lumbar facet joint pain. There are two types of radiofrequency applications for radiofrequency neurolysis as pulsed radiofrequency and conventional radiofrequency. Materials and Methods Patients with lumbar facet pain were separated into 2 groups. Group 1 (n=75): patients were given pulsed radiofrequency under fluoroscopy. Group 2 (n=43): patients were given conventional radiofrequency under fluoroscopy. Pre-op and post-op 1st, 3rd, and 6th month and 1st and 2nd year Visual Analogue Scale values of all patients were asked, recorded, and statistically compared. Visual Analogue Scale values of the groups in the same months were compared as well. At the end of the second year, Odom criteria of both groups were recorded and statistically compared. Results Preoperation Visual Analogue Scale values and postoperation 1st, 3rd, and 6th month and 1st and 2nd year Visual Analogue Scale values were compared in Group 1 and Group 2, and there was a statistically significant difference between preoperation Visual Analogue Scale values and postoperation 1st, 3rd, and 6th month and 1st and 2nd year Visual Analogue Scale values in both groups. However, the number of repetitions of the operation was higher in Group 1. In the comparison of Odom criteria for both groups at the end of the second year, it was observed that the patients in Group 2 were more satisfied with the treatment. Conclusion Conventional radiofrequency in patients with lumbar facet joint pain for medial branch neurolysis effectively decreases Visual Analogue Scale values in both short and long term. The quality of life and daily activities of patients were better at conventional radiofrequency.

The Effectiveness of Pulsed Radiofrequency on Joint Pain: A Narrative Review

“…As for the other 6 previous studies, 2 prospective observational studies, 3 retrospective studies, and 1 case report were reported. In all 6 studies, after medial branch or IA PRF stimulation, significant pain reduction and functional improvement were observed.…”

“…Thus far, 10 previous studies have reported the effect of PRF stimulation on lumbosacral facet joint pain . Of these, 4 studies were randomized trials .…”

Termolezja — interwencyjna metoda leczenia przewlekłego bólu: mechanizmy działania przeciwbólowego, wskazania oraz zastosowanie w wybranych zespołach bólowych

“…It is recommended to carry out a repeated blockade of facet joints with the application of different local anaesthetics (LA) in order to precisely specify the location of the painful joint and the estimation of the duration of action of the LA. Full or significant pain relief after a local blockade as felt by the patient within a period corresponding to the duration of action of LA confirms a correct estimation of the area of origin of the pain where radiofrequency should be carried out [1,13]. The authors have proven that CRF in the examined group of patients caused an effective pain relief (NRS < 5) in 88.38% of patients, both within a short (1, 3, 6 months), as well as a longer (1, 2 years) observation period.…”

“…Cetin and Yektas compared the efficacy of CRF and PRF in the treatment of lumbar facet joint related low back pain (facet joint syndrome). It is believed that the 'gold standard' for the treatment of this pain syndrome is the radiofrequency of the medial branches of the dorsal arms that innervate the facet joints -1B+ according to Evidence-Based Medicine (EBM) [13,14]. It is recommended to carry out a repeated blockade of facet joints with the application of different local anaesthetics (LA) in order to precisely specify the location of the painful joint and the estimation of the duration of action of the LA.…”

“…A side effect of such radiofrequency procedure is the possibility of the above-mentioned neurogenic inflammation, usually treated with the use of NSAIDs. In contrast to CRF, PRF uses an impulse stimulation, subjecting tissues to the effect of an electric field of lower temperature of 42-45°C which, very rarely, causes its lesion [1,2,4,13].…”