Thoracic Zygapophysial Joint Thermal Neurotomy: A Cohort Revealing Additional Outcomes by Specific Joint Groupings.

Abstract

Thoracic spinal pain is common, and patients with this type of pain have limited therapeutic options. The cohort in this study received diagnostic intra-articular zygapophysial joint injections leading to thermal neurotomy to the medial branch nerves to demonstrate improved pain as well as physical and psychological function. A consecutive cohort from 2012 to 2018 with retrospective analysis of prospectively gathered data. A private multidisciplinary pain clinic with referrals from primary care. Forty-six complete data sets from 39 patients were found using a pre-procedure and 3-month post-procedure questionnaire. Further follow-up results were found for the dual primary outcomes of duration of ≥50% relief using a numeric rating scale (NRS) for the entire group. The group was then divided into three subgroups of T1/2-T3/4, T4/5-T8/9, and T9/10-T12/L1. Success rates of 63% for ≥3months of ≥50% relief and 46% for ≥6months of ≥50% relief were found, for an average duration of 7.8 months. Group mean change in the NRS was 6.7, decreasing to 4.3 (P<0.0001). For the first time, there are data showing that the three groups of T1/2-T3/4, T4/5-T8/9, and T9/10-T12/L1 responded equally. Secondary outcomes of physical and psychological function using the Functional Rating Index (FRI) and the Depression Anxiety Stress Scale (DASS) all showed significant improvements with small to moderate effect sizes and with all achieving >36% improvement in scores. This cohort demonstrates that there is a pragmatic diagnostic and therapeutic option available for patients with thoracic zygapophysial joint pain that can achieve 50-100% of pain relief in 63% of patients with improved physical and psychological function.