Randomized prospective trial of cooled versus traditional radiofrequency ablation of the medial branch nerves for the treatment of lumbar facet joint pain

Abstract

Background and objectivesNo previous study has assessed the outcomes of cooled radiofrequency ablation (C-RFA) of the medial branch nerves (MBN) for the treatment of lumbar facet joint pain nor compared its effectiveness with traditional RFA (T-RFA). This study evaluated 6-month outcomes for pain, function, psychometrics, and medication usage in patients who underwent MBN C-RFA versus T-RFA for lumbar Z-joint pain.MethodsIn this blinded, prospective trial, patients with positive diagnostic MBN blocks (>75% relief) were randomized to MBN C-RFA or T-RFA. The primary outcome was the proportion of ‘responders’ (≥50% Numeric Rating Scale (NRS) reduction) at 6 months. Secondary outcomes included NRS, Oswestry Disability Index (ODI), and Patient Global Impression of Change.ResultsForty-three participants were randomized to MBN C-RFA (n=21) or T-RFA (n=22). There were no significant differences in demographic variables (p>0.05). A ≥50% NRS reduction was observed in 52% (95% CI 31% to 74%) and 44% (95% CI 22% to 69%) of participants in the C-RFA and T-RFA groups, respectively (p=0.75). A ≥15-point or ≥30% reduction in ODI score was observed in 62% (95% CI 38% to 82%) and 44% (95% CI 22% to 69%) of participants in the C-RFA and T-RFA groups, respectively (p=0.21).ConclusionsWhen using a single diagnostic block paradigm with a threshold of >75% pain reduction, both treatment with both C-RFA and T-RFA resulted in a success rate of approximately 50% when defined by both improvement in pain and physical function at 6-month follow-up. While the success rate was higher in the C-RFA group, this difference was not statistically significant.Trial registration number NCT02478437.

The efficacy and safety of cooled-radiofrequency neurotomy in the treatment of chronic thoracic facet (zygapophyseal) joint pain

“…There was one randomized prospective comparative study investigating the effectiveness of TRFA versus CRFA in ablation of the medial branch nerves for the treatment of facet joint pain in the lumbar spine. [ 12 ] In this study, investigators were not able to demonstrate any meaningful difference in treatment outcomes between CRFA as compared with TRFA.…”

“…[ 5 , 6 ] There is only single study comparing the TRFA versus CRFA in the lumbar spine. [ 12 ] However, available evidence for thoracic spine TRFA is very limited in the medical literature. [ 7 ] There are limited cadaveric studies and case reports regarding the CRFA, but to our knowledge, this is the first clinical study to evaluate the efficacy and adverse effects of CRFA for the facet joint-related pain in the thoracic spine.…”

Preoperative facet joint arthropathy does not impact long-term clinical outcomes after lumbar-stability-preserving decompression and dynesys fixation

“…Chronic low back pain along with sciatica can be conservatively managed with physical therapy and pain medication 1 . For patients failing conservative management, lumbar radiofrequency ablation of the medial branch nerves may be performed 8 . Such nerve ablation causes sensory or sympathetic denervation, thereby ameliorating low back pain; however, recurrence of lower back pain may happen because of axonal regeneration 1 , 9 .…”

Peri‐procedural Management of Implanted Spinal Cord Stimulators in Patients Undergoing Radiofrequency Ablation: A Case Report and Manufacturer‐Specific Recommendations

“…Due to clinical concern and risk for motor impairment and deafferentation syndrome, the clinical use of conventional RFA to treat pain has mostly been limited to targeting of sensory nerves . Presently, within the realm of pain medicine, conventional RFA has been utilized as a therapy to treat axial spine pain arising from spondylosis without myelopathy, hip and knee joint pain, sacroiliac joint pain, visceral pain syndromes, or central injuries . If one considers the use of pulsed and cooled RFA, and non‐pain‐related indications for RFA, then the list of therapeutic applications tremendously expands since this technology is pervasively embraced throughout a multitude of medical disciplines.…”

“…5 Presently, within the realm of pain medicine, conventional RFA has been utilized as a therapy to treat axial spine pain arising from spondylosis without myelopathy, hip and knee joint pain, sacroiliac joint pain, visceral pain syndromes, or central injuries. 6,7 If one considers the use of pulsed and cooled RFA, and non-pain-related indications for RFA, then the list of therapeutic applications tremendously expands since this technology is pervasively embraced throughout a multitude of medical disciplines. Interestingly, as our medical and social interest in finding alternatives to opioid therapy continues to grow, there is cogent evidence that the use of various RFA treatments may offer patients valuable relief from pain and avoidance of opioid use.…”