Other: Role of pulse radiofrequency rhizotomy in the management of cervicobrachial pain

Abstract

Stereotactic radiofrequency rhizotomy (RFTC)has shown promise in the treatment of cervicobrachial pain of facet origin. The purpose was to study the efficacy of pulsed RFTC for the treatment of cervicobrachial pain. Patients between 2000-2002, with cervicobrachial pain fulfilling inclusion criteria underwent pulse RFTC were followed at 3 and 6 months using verbal analog scale (VAS, 0-10) and headache days per month. A neurologist collected the data and information regarding post-operative complications. Cervicobrachial pain, normal neurological examination, normal imaging study (CT or MRI), pain relief of at least 80% by medial branch blocks twice (ISIS technique/criteria). The procedure was done using posterior approach, under fluoroscopy. A sensory stimulation of less than 0.4 mv was used as the upper acceptable limit. 52 patients were treated, 38 women and 14 men. The procedure was successful in 40/52 (77%) patients and 12/52 (23%) did not obtain any pain relief. Pre- and post-treatment data was analyzed with t-tests. Patients reported a mean pre-treatment VAS of 7.51 (SD=3.37) and a mean number of headache days per month of 12.31 (SD=4.06). At 3 months post-treatment, the mean VAS fell to 1.69 (SD=2.27) and mean headache days to 2.63 (SD=3.41). VAS at 6 months post-treatment had a mean of 2.14 (SD=3.37), while mean headache days were reported at 2.96 (SD=4.99). Changes in pain VAS were significant from pre-treatment to both 3-month p<.001 and 6-month scores p<.001. Number of headache days per month also were significantly lower at 3-months p<.001 and 6-months p<.001. No post procedural neurologic complications were reported. Stereotactic radiofrequency rhizotomy using the pulse technique is a safe and effective procedure for the treatment of cervicobrachial pain providing long-term pain relief.