(477) Radiofrequency ablation for chronic back pain: a comparison of two techniques of radiofrequency ablation for the management of lumbar facet syndrome

Abstract

Chronic back pain is a common health issue and has a negative impact on the quality of life. The facet joints are a common source of pain. Inflammation/injury to lumbar facet joints can lead to the development of lumbar facet syndrome. We present a case of a 71-year-old female with a chronic history of lower back pain who was diagnosed with bilateral lumbar facet syndrome in 2013. She underwent conventional radiofrequency ablation (RFA) of L3, L4, and L5 medial branch nerves on the left side and endoscopic RFA of L3, L4, and L5 nerves on the right side within a one-month period in 2013. We then compared the effectiveness of both techniques on long-term pain relief. Prior to 2013, she had tried medical management, physical therapy, medial branch blocks, previous RFA, lumbar epidural and sacroiliac joint steroid injections all resulting with recurrence of pain. After undergoing both methods of RFA in 2013, her back pain has resolved for 24 months. There was insignificant difference in pain relief between conventional and endoscopic RFA. The patient had complete pain relief with conventional RFA for 15 months after which she experienced occasional, mild pain on the left side, relieved with pain medication. At 24 months, the patient has been pain free on the endoscopic side. Endoscopic guided RFA is a newer method of RFA, with the advantage of direct visualization of affected nerves, but disadvantages include longer duration of procedure, lengthened recovery time, prolonged anesthesia, increased cost, and potential cosmetic scarring. We concluded that both conventional and endoscopic RFA have similar effects on long-term pain relief. Our patient has had substantial pain relief for 24 months. Comparing the advantages and disadvantages of endoscopic versus conventional fluoroscopic guided RFA and based on the comparable outcomes, conventional fluoroscopic medial branch RFA is a preferable technique.