Chronic lumbar facet joint pain. Treatment results using percutaneous rhizolysis. Patient selection and surgical technique

Abstract

Purpose To evaluate the efficacy of percutaneous radiofrequency zygapophysial joint neurotomy (rhizotomy) to decrease pain and improve associated disability, in a group of patients suffering from low back pain from facet joint origin meticulously selected on the basis of a combination of clinical findings, physical examination, imaging tests and anaesthetic diagnostic blocks. Materials and methods Prospective study with 70 patients treated with rhizotomy for low back pain from facet joint origin longer than three months who did not improved after conservative treatment. Patients evaluated following the guidelines of the Spanish Society for the Study of the Spinal Diseases (GEER). Mean age was 49.52 years. Mean duration of pain: 6.86 years. Minimum follow-up: one year. Results Following percutaneous rhizotomy, mean low back pain as measured on the Visual Analogue Scale (VAS), decreased significantly (p<0.05). Likewise, there was a significant improvement in the values given for the Oswestry Disability Index (ODI) reflecting a notable improvement in terms of quality of life (p<0.05). Following rhizotomy 91.4% of patients reported significant pain relief, which was higher than or equal to six months in 61.4% of patients. At one year, 84.5% of patients stated that they would undergo the same treatment again, showing high satisfaction with the treatment received. Conclusions Percutaneous rhizotomy can be considered a valuable treatment for the symptomatic relief of chronic low back pain from facet joint origin. Meticulous patient selection by combining clinical and physical findings, imaging tests, and anaesthetic diagnostic blocks, provides significant and lasting pain relief, contributing to a reduction of the associated disability in patients suffering from chronic low back pain.