Percutaneous Radiofrequency Neurotomy in the Treatment of Cervical Zygapophysial Joint Pain

Abstract

Percutaneous radiofrequency neurotomy has been used in the treatment of pain from the cervical zygapophysial joints, but the results have been modest and not compelling. Several factors might account for its apparent poor success rate, including inadequate patient selection, inaccurate surgical anatomy, and technical errors. In an effort to overcome these confounders, we used comparative local anesthetic blocks to preoperatively, definitively diagnose cervical zygapophysial joint pain and developed an amended operative technique based on formal anatomical studies. An audit was conducted of our experience with 19 patients to determine whether there was sufficient merit in the amended procedure to justify a randomized, double-blind, controlled trial. The duration of complete pain relief was the principal outcome measure. Side effects and complications were also monitored. Of the 10 patients who underwent third occipital neurotomy for the treatment of C2-C3 zygapophysial joint pain, only 4 obtained long-lasting relief. The other six patients reported an early return of their pain and constituted technical failures; the third occipital nerve was inadequately coagulated and recovered in the immediate postoperative period. Of the 10 patients who underwent lower cervical medial branch neurotomy, 7 obtained complete pain relief for clinically useful periods and were able to resume their activities of daily living and employment. After procedures at all levels, a brief period of postoperative pain was experienced by the patients and ataxia was a side effect of third occipital neurotomy. There were no cases of postoperative infection or anesthesia dolorosa. Given the high technical failure rate of third occipital neurotomy, we recommend that this procedure be abandoned until the technical problems can be overcome.(ABSTRACT TRUNCATED AT 250 WORDS)

The role of radiofrequency in the treatment of mechanical pain of spinal origin

“…Patients who were suffering LBP and had osteoarthritic changes in their facet joints (facet syndrome) underwent RF ablation of the medial branch of the dorsal ramus [2,9,10,12,14,15,17,19,21,20]. Denervation was performed in an ambulatory outpatients setting under local anesthesia of the superficial tissue layers using 1% lidocaine and with fluoroscopic guidance.…”

“…After sensor stimulation with 50 Hz and motor stimulation with 2 Hz, 0.5 cc of local anesthetic (2% lidocaine) and 80 mg depomedrol were injected. The ablation was done with a core temperature of 80°C around the electrode tip [9,12,17,19]. For ablation of the cervical medial branch we used the postero-lateral approach [18].…”

Headaches in the whiplash syndrome

“…Percutaneous radiofrequency neurotomy was similarly unsatisfactory in Lord et al's attempted treatment of the zygapophyseal joints that they believe are responsible for much whiplash neck and head pain. 18 The present study disclosed that nine patients (18.7%) had forgotten or suppressed their history of pre-accident headache. The reasons lend themselves to conjecture, and relate to other factors in some of those seeking compensation.…”

The myth of chronic whiplash syndrome

“…25 Percutaneous radiofrequency neurotomy has therefore been used by the same authors in the treatment of pain from the cervical zygapophysial joints, but the results, they say, have been variable, 25 modest and not compelling. 27 Similarly, they acknowledged their failure with steroid injections into zygapophysial joints, third occipital neurotomy, and of radiofrequency lesions used for long-term treatment. These meticulous studies inculpate the joints only by indirect means.…”