Outcomes and prognostic variables of radiofrequency zygapophyseal joint neurotomy in Utah workers&amp;rsquo; compensation patients

Christensen, Tyler J.; DeBerard, M. Scott; Wheeler, Anthony J.

doi:10.2147/jpr.s132853

Cited by 5 publications

(7 citation statements)

References 32 publications

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“… 46 Patient factors predictive of poor success with lumbar or cervical RFA include advanced age, certain pain referral patterns and physical exam signs, opioid use, prior history of depression, previous back surgery, longer duration of pain, and ongoing legal action. 47 – 49 In individuals with chronic neck pain due to whiplash, low levels of pain catastrophizing and functional disability were found to be predictive of success with cervical RFA. 50 In a study evaluating prognostic factors before PRF of the occipital nerves, treatment failure was associated with extension of pain beyond the confines of the targeted nerve distribution, while a lower diagnostic block volume, multiple treatment cycles, and a traumatic precipitating event predicted success.…”

Section: Introductionmentioning

confidence: 99%

Radiofrequency techniques to treat chronic knee pain: a comprehensive review of anatomy, effectiveness, treatment parameters, and patient selection

Jamison

Cohen

2018

JPR

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BackgroundThe use of radiofrequency ablation (RFA) procedures to treat chronic knee pain has surged in the past decade, though many questions remain regarding anatomical targets, selection criteria, and evidence for effectiveness.MethodsA comprehensive literature review was performed on anatomy, selection criteria, technical parameters, results of clinical studies, and complications. Databases searched included MEDLINE and Google Scholar, with all types of clinical and preclinical studies considered.ResultsWe identified nine relevant clinical trials, which included 592 patients, evaluating knee RFA for osteoarthritis and persistent postsurgical pain. These included one randomized, placebo-controlled trial, one randomized controlled trial evaluating RFA as add-on therapy, four comparative-effectiveness studies, two randomized trials comparing different techniques and treatment paradigms, and one non-randomized, controlled trial. The results of these studies demonstrate significant benefit for both reduction and functional improvement lasting between 3 and 12 months, with questionable utility for prognostic blocks. There was considerable variation in the described neuroanatomy, neural targets, radiofrequency technique, and selection criteria.ConclusionRFA of the knee appears to be a viable and effective treatment option, providing significant benefit to well-selected patients lasting at least 3 months. More research is needed to better identify neural targets, refine selection criteria to include the use of prognostic blocks, optimize treatment parameters, and better elucidate relative effectiveness compared to other treatments.

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Section: Introductionmentioning

confidence: 99%

Radiofrequency techniques to treat chronic knee pain: a comprehensive review of anatomy, effectiveness, treatment parameters, and patient selection

Jamison

Cohen

2018

JPR

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“…Consistent with the biopsychosocial model of pain, studies have shown that some psychological, social factors and biological factors (previous surgery, radicular signs, predominantly midline pain) have a greater risk for poorer radiofrequency outcomes 82–84 . Studies have found depression, substance misuse, younger age, a greater Cobb angle and more non‐organic (Waddell) signs to be associated with negative lumbar facet radiofrequency outcomes 82 .…”

Section: Treatment Optionsmentioning

confidence: 88%

“…Studies have found depression, substance misuse, younger age, a greater Cobb angle and more non‐organic (Waddell) signs to be associated with negative lumbar facet radiofrequency outcomes 82 . In one study evaluating outcomes in 101 Worker's compensation cases, retaining an attorney was associated with a >7‐fold increased risk of post‐treatment physical disability, along with greater bodily pain, functional impairment, and less vitality 83 . Since most chronic low back pain patients present with concomitant lumbar pain generators and psychosocial risk factors, one should ideally consider an interdisciplinary, multimodal treatment approach that includes addressing the most pressing and impactful conditions.…”

Section: Treatment Optionsmentioning

confidence: 99%

3. Pain originating from the lumbar facet joints

Van den Heuvel,

Cohen,

de Andrès Ares

et al. 2023

Pain Practice

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IntroductionPain 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.MethodsThe literature on the diagnosis and treatment of lumbar facet joint pain was retrieved and summarized.ResultsThere 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.ConclusionsWell‐selected individuals with chronic low back originating from the facet joints may benefit from lumbar medial branch radiofrequency ablation.

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“…Christensen et al. [ 24 ] demonstrated that a prior history of depression was determined to be a significant predictor of neurotomy failure in zygapophyseal joints. In addition, pain catastrophizing has been implicated as a link between increased chronic pain and mental health disorders [ [25] , [26] , [27] ].…”

Section: Discussionmentioning

confidence: 99%

Is Cooled Radiofrequency Genicular Nerve Block and Ablation a Viable Option for the Treatment of Knee Osteoarthritis?

et al. 2021

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Background The purpose of this study was to determine demographic and psychosocial factors that influence the effectiveness of cooled radiofrequency genicular nerve ablation (C-RFA) and block in patients with chronic knee pain secondary to osteoarthritis (OA). Methods A retrospective review was completed including patients with knee OA who underwent genicular nerve ablation or block or both. Patient information collected included opioid use, psychological comorbidities, smoking history, body mass index, and medical comorbidities. Success was defined using the Osteoarthritis Research Society International criterion of greater than or equal to 50% reported pain relief from the procedure. Patients without a diagnosis of knee OA and patients with ipsilateral total knee arthroplasty were excluded. Patient factors were compared between (1) those that did or did not respond to the initial block and (2) those that did or did not respond to C-RFA. Results Of the 176 subjects that underwent genicular nerve block, 31.8% failed to respond to the procedure. Subjects that failed the initial block were significantly more likely to have psychological comorbidities, smoking history, and diabetes. Of the subjects that proceeded to genicular nerve ablation, 53.7% reported less than 50% pain relief, and 46.3% reported pain relief greater than or equal to 50% at the first follow-up visit. While the presence of psychological comorbidities, smoking, and diabetes were associated with first-stage block failures, these patient factors were not associated with second-stage ablation failures. Conclusions C-RFA may be an effective adjunct therapy as part of a multimodal pain regimen; however, individual patient characteristics must be considered.

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Outcomes and prognostic variables of radiofrequency zygapophyseal joint neurotomy in Utah workers’ compensation patients

Cited by 5 publications

References 32 publications

Radiofrequency techniques to treat chronic knee pain: a comprehensive review of anatomy, effectiveness, treatment parameters, and patient selection

Radiofrequency techniques to treat chronic knee pain: a comprehensive review of anatomy, effectiveness, treatment parameters, and patient selection

3. Pain originating from the lumbar facet joints

Is Cooled Radiofrequency Genicular Nerve Block and Ablation a Viable Option for the Treatment of Knee Osteoarthritis?

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