Radiofrequency Denervation Of Facet Joints Research Articles

Treatment of spondyloarthritis (facet syndrome) by puncture techniques

Objective. The aim of the study was to determine effectiveness of radiofrequency denervation of facet joints in combination with periarticular administration of local anaesthetics and steroids for elimination of pain in patients with low lumbar pain and predominantly spondyloarthritis. Material and methods. 78 patients with lower lumbar pain syndrome and arcuate joints arthrosis as a leading clinical manifestation underwent radiofrequency denervation of facet joints and periarticular administration of local anaesthetic and steroid drug (main group). The control group involved 136 patients with lumbar pain and dominating spondylarthritis treated only by radiofrequency denervation of facet joints. Results. Both in the early and late periods after treatment, reliable results were obtained in treatment of chronic lower lumbar pain caused mainly by arcuate joints damage both in the main and control groups. However, there was a significant difference between the main group and the control group in the early period (in three months after treatment), in favour of the main group. In the late period (in 1 year after treatment) a reliable treatment result was obtained both in the main and control groups, but there was no difference in the treatment results between these groups. Conclusions. Periarticular administration of local anaesthetics and steroids is effective in the short term, and radiofrequency denervation of facet joints is effective in both the short and longer term.

RADIOFREQUENCY DENERVATION OF THE FACET JOINTS AND LOCAL PERIARTICULAR ADMINISTRATION OF ANAESTHETICS IN FACET SYNDROME TREATMENT.

The aim: To determine the effectiveness of radiofrequency denervation of the facet joints in combination with periarticular administration of local anaesthetics in patients with facet syndrome. Materials and methods: The early and long-term results of treatment patients with facet syndrome were analysed. The Visual Analogue Scale of pain and the Oswestry Disability Index were used. The 47 patients underwent radiofrequency denervation of the facet joints in combination with periarticular administration of local anaesthetics (the main group). The 136 patients underwent only radiofrequency denervation of the facet joints (control group). Results: Immediately after the treatment as well as in 3 months and in 1 year after it, a reliable results of treatment of facet syndrome in both the main and the control groups was attained. At the same time, there were significant differences between the main group and the control group immediately after treatment. But in 3 months and in 1 year after it there were no such differences that proved a significantly higher efficiency of high radiofrequency denervation of facet joints in combination with periarticular administration of local anaesthetics in the early postoperative period. Conclusions: The radiofrequency denervation of the facet joints has proved to be an effective method of treatment of patients with spondyloarthritis both in the short and long term outcomes. Periarticular administration of local anaesthetics enhances the effectiveness of radiofrequency denervation of the facet joints only for the short term outcomes.

MR-guided lumbar facet radiofrequency denervation for treatment of patients with chronic low back pain in an open 1.0 Tesla MRI system.

BackgroundTo evaluate the feasibility, safety and efficacy of magnetic resonance imaging (MRI)-guided lumbar facet joint radiofrequency denervation (FRD) in patients with chronic low back pain.MethodsThe study consisted of two parts. First, a preclinical analysis using an ex vivo animal model was performed to define optimal technical parameters for ablation. Then, 17 patients with chronic lumbar facet joint pain syndrome were prospectively included and underwent MRI-guided FRD in an open 1.0-Tesla MRI. We analyzed technical feasibility and complications as well as clinical outcome in terms of subjective pain assessed on a numerical visual analogue scale (VAS) before and after 1 week/6 months after FRD. Clinical assessment was complemented by measurement of paravertebral muscle volume and fat content before the intervention and at 6-month follow-up.ResultsAll interventions were technically successful without major complications. Initial VAS scores (median: 8, IQR: 1, range: 6–9, CI: 7.14–8.04) decreased significantly both after one week (median: 4, IQR: 5, range: 0–7, CI: 1.9–4.69, P=0.003) and after 6 months (median: 1, IQR: 6, range: 0–7, CI: 1.06–4.23, P<0.001). Mean multifidus muscle volume increased significantly in the patient population (from 366.8±130.8 cm3 before to 435.4±146.7 cm3 after FRD, P=0.031).ConclusionsThis proof of principle study shows MRI-guided FRD in an open 1.0-Tesla MRI system to be a potential therapy option for patients with chronic low back pain.

Efficiency and duration of radiofrequency denervation of facet joints for lower back pain

<h3></h3> Боль в спине — одна из ведущих жалоб при обращении к неврологу лиц трудоспособного и пожилого возраста. Спонтанный регресс болевого синдрома в течение 6 нед наблюдается у 50% пациентов. Остальные случаи требуют активного медицинского вмешательства. Несмотря на обилие обезболивающих и нестероидных противовоспалительных препаратов, не всегда удается достичь адекватного купирования боли. Один из самых распространенных источников хронической боли в спине — фасеточный сустав. Наиболее безопасным и эффективным методом лечения является радиочастотная денервация фасеточных суставов. В обзоре представлены современные данные об эффективности и безопасности применения радиочастотной денервации у пациентов с болью в спине, обусловленной поражением фасеточных суставов, а также об изменениях качества жизни таких пациентов.

Back pain: from diagnosis to treatment

In today ‘s world, back pain is a heavy burden and leads to a decrease in the working capacity, quality of life of people. The choice of tactics of treatment of pain in a back is defined by the pain reason: nonspecific pain, the specific pain caused by serious diseases or a compression of a root. The most frequent cause of back pain is nonspecific pain due to myofascial, muscular-tonic syndrome, facet syndrome, and sacral-iliac joint dysfunction in lower back pain. The article presents clinical symptoms of these syndrome, as well as techniques of neuroorthopedic examination, which allow to detect one or more abrasions of back pain. To prevent acute non-specific pain, it is recommended to prescribe non-steroidal anti-inflammatory drugs (NSAID) and muscle relaxants. Along with pharmacological treatments, treatment of patients with back pain should be more comprehensive and include cognitive-behavioral therapy and kinesiotherapy. Determination of the source of back pain in neuroorthopedic examination makes it possible to carry out local therapy in stages using blockages with local anesthetics and glucocorticoids. In case of insufficient effectiveness of blockades, it is possible to carry out radiofrequency denervation of facet joints or sacral-iliac). Clinical and neuroorthopedic examination of a patient with back pain with identification of sources of pain, analysis of the causes that led to its development, adequate treatment and recommendations to prevent repeated exacerbations can significantly reduce the risk of chronization of back pain and improve the quality of life of patients.

Radiofrequency facet joint denervation efficiency based on the severity of spondylarthrosis and in osteoporotic vertebral compression fractures. A retrospective study

ObjectivesRadiofrequency denervation of the facet joints is performed via a well-established method. Its primary, direct indication is a positive response to a nerve block injection (MBB). Our study aimed to find other, effective but indirect indication signs through the retrospective analysis of our patients treated earlier. Patients and methodsIn our institute between 1 January, 2008 and 31 December, 2017 facet joint denervation has been performed in more than 2000 cases, and we included 529 patients in our retrospective study. We had separate groups for vertebral compression fractures and for spondylarthrosis of different severity (Grade 1; 2–3; 4), thus we assessed the postoperative condition of these patients using Visual Analoge Scale (VAS). The efficacy of the intervention was examined in every groups separately according to symptoms and previous spine surgeries. ResultsIn view of our results, chronic lumbago and dorsalgia that are attributable to osteoporotic vertebral compression fracture are obvious indications if they do not respond to conservative therapy, as 76.8% of such patients remained asymptomatic for minimum 6 months (p = 0,000). Another indication is Grade 2 or 3 chronic spondylarthrosis without radicular involvement, since these groups reported a 51.4% success rate (asymptomatic for minimum 6 months) (p = 0,015). Long term pain relief is obviously impaired by the presence of radicular compression, as we were not able to decrease the pain of 97% of such patients. Our findings also suggest that the vast majority of those who have previously undergone spine surgery cannot benefit from the intervention. ConclusionBased on this study, facet joint denervation can serve as an effective therapy supplement in a properly selected group of patients who do not respond to oral NSAIDs, exercise and physiotherapy. By this procedure we found we can reach long term benefit in the groups of osteoporotic vertebral fracture patients and patients with moderate spondylarthrosis. According to our results and the literature datas the properly patient selection for the indication of the RF ablation can be as effective as the controversial diagnostic nerve block injections.

Results of treatment of low lumbar pain syndrome by radiofrequency denervation of the facet joints

Background. The high prevalence of degenerative-dystrophic spine injury and low effectiveness of spondyloarthritis therapy makes relevant the treatment of low lumbar pain syndrome caused mainly by spondyloarthritis by innovative minimally invasive method of high-frequency denervation of facet joints.Purposes. To determine the effectiveness of the radiofrequency denervation of facet joints, taking into account early and long-term results of treatment, to eliminate the pain syndrome in patients with lower lumbar pain syndrome with predominating spondyloarthritis.Materials and methods. The early and long-term results of treatment by the method of high-frequency denervation of facet joints were analyzed using 1RFG-1A/RFG-1B (produced by Radionics) in 136 patients (73 men and 63 women aged from 44 to 81 years) with lower lumbar pain syndrome with the leading clinical manifestation of arthrosis of the articular joints. The pain syndrome was assessed four times – in the preoperative and postoperative periods (during the week), 3 months and a year after treatment. The visual analogue scale (VAS) of pain and the Oswestry index of disability index were used. The control group consisted of 31 patients (15 women and 16 men aged from 42 to 83 years) with lower lumbar pain with spondyloarthrosis dominating, which were treated non-operatively.Results. Immediately after treatment, a reliable result of treatment of chronic low-back pain syndrome in the basic and control groups with all structural and morphological changes of the spine was obtained both by the Oswestry disability scale and the visual analogue scale of pain (except the control group where spondyloarthritis was combined with large herniated discs, spinal stenosis, spondylolisthesis). Meanwhile there is clear and reliable difference between the basic group and the control group immediately after the treatment. After three months and a year after the treatment in both groups a reliable result was obtained only in the basic group, which indicates high efficiency of radiofrequency denervation of facet joints.Conclusions. Both early and long-term treatment results demonstrate efficacy and safety of high-frequency denervation of facet joints in patients with lower lumbar pain syndrome with spondyloarthrosis dominating. High-frequency denervation of facet joints should be included in the algorithm of treatment of facet syndrome in case of the ineffectiveness of drug treatment.

The Effect and Role of Steroids in Facet Joint Radiofrequency Denervation: a Narrative Review

Purpose of Review There is ongoing controversy regarding the role of steroids in facet joint radiofrequency denervation and its associated side effects. We reviewed the available evidence to ascertain whether steroids confer any therapeutic value, affect lesion size, or prevent neuritis among other considerations.

Radiofrequency denervation for chronic low back pain.

Radiofrequency (RF) denervation, an invasive treatment for chronic low back pain (CLBP), is used most often for pain suspected to arise from facet joints, sacroiliac (SI) joints or discs. Many (uncontrolled) studies have shown substantial variation in its use between countries and continued uncertainty regarding its effectiveness. The objective of this review is to assess the effectiveness of RF denervation procedures for the treatment of patients with CLBP. The current review is an update of the review conducted in 2003. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, three other databases, two clinical trials registries and the reference lists of included studies from inception to May 2014 for randomised controlled trials (RCTs) fulfilling the inclusion criteria. We updated this search in June 2015, but we have not yet incorporated these results. We included RCTs of RF denervation for patients with CLBP who had a positive response to a diagnostic block or discography. We applied no language or date restrictions. Pairs of review authors independently selected RCTs, extracted data and assessed risk of bias (RoB) and clinical relevance using standardised forms. We performed meta-analyses with clinically homogeneous studies and assessed the quality of evidence for each outcome using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. In total, we included 23 RCTs (N = 1309), 13 of which (56%) had low RoB. We included both men and women with a mean age of 50.6 years. We assessed the overall quality of the evidence as very low to moderate. Twelve studies examined suspected facet joint pain, five studies disc pain, two studies SI joint pain, two studies radicular CLBP, one study suspected radiating low back pain and one study CLBP with or without suspected radiation. Overall, moderate evidence suggests that facet joint RF denervation has a greater effect on pain compared with placebo over the short term (mean difference (MD) -1.47, 95% confidence interval (CI) -2.28 to -0.67). Low-quality evidence indicates that facet joint RF denervation is more effective than placebo for function over the short term (MD -5.53, 95% CI -8.66 to -2.40) and over the long term (MD -3.70, 95% CI -6.94 to -0.47). Evidence of very low to low quality shows that facet joint RF denervation is more effective for pain than steroid injections over the short (MD -2.23, 95% CI -2.38 to -2.08), intermediate (MD -2.13, 95% CI -3.45 to -0.81), and long term (MD -2.65, 95% CI -3.43 to -1.88). RF denervation used for disc pain produces conflicting results, with no effects for RF denervation compared with placebo over the short and intermediate term, and small effects for RF denervation over the long term for pain relief (MD -1.63, 95% CI -2.58 to -0.68) and improved function (MD -6.75, 95% CI -13.42 to -0.09). Lack of evidence of short-term effectiveness undermines the clinical plausibility of intermediate-term or long-term effectiveness. When RF denervation is used for SI joint pain, low-quality evidence reveals no differences from placebo in effects on pain (MD -2.12, 95% CI -5.45 to 1.21) and function (MD -14.06, 95% CI -30.42 to 2.30) over the short term, and one study shows a small effect on both pain and function over the intermediate term. RF denervation is an invasive procedure that can cause a variety of complications. The quality and size of original studies were inadequate to permit assessment of how often complications occur. The review authors found no high-quality evidence suggesting that RF denervation provides pain relief for patients with CLBP. Similarly, we identified no convincing evidence to show that this treatment improves function. Overall, the current evidence for RF denervation for CLBP is very low to moderate in quality; high-quality evidence is lacking. High-quality RCTs with larger patient samples are needed, as are data on long-term effects.

Percutaneous Radiofrequency Facet Joint Denervation With Monitoring of Compound Muscle Action Potential of the Multifidus Muscle Group for Treating Chronic Low Back Pain

A retrospective review. The aim of this study was to study the effectiveness of percutaneous radiofrequency neurotomy of facet joints by monitoring compound muscle action potentials (CMAPs) of the multifidus muscle group as an objective index of treatment efficacy. Percutaneous radiofrequency neurotomy of the medial branches of the dorsal rami of the lumbar nerves is a widely accepted treatment for chronic lumbar intervertebral joint pain. However, its success rate has varied in different studies because an objective method for evaluating the facet joint denervation is lacking. Fifty-five patients (age range, 19-76 y; mean age, 55 y) with low back pain persisting for ≥3 months, in whom facet block and/or block of the medial branch of the dorsal ramus were only temporarily effective, were included. The Japanese Orthopaedic Association (JOA) scoring system for back pain was used for clinical assessment. JOA scores were measured before treatment and 1 week, 3 months, 6 months, and 12 months afterward. The improvement rate was calculated with ≥40% improvement rate defined as successful, and the success rate was subsequently evaluated. The patient success rate was 75% (41/55) at 1 week, 71% (39/55) at 3 months, 60% (33/55) at 6 months, and 51% (28/55) at 12 months after treatment. Two cases had minor postoperative complications, which were localized burning pain lasting <1 week at the site of electrode insertion. Our results suggest that percutaneous radiofrequency facet joint denervation with CMAPs monitoring is a safe, long-lasting, and effective treatment for chronic facet joint pain. CMAP monitoring may be useful as an objective index for facet denervation.

Radiofrequency denervation for facet joint low back pain: a systematic review.

A systematic review and meta-analysis of randomized controlled trials. To assess treatment effects (benefits and harms) of radiofrequency denervation for patients with facet joint-related chronic low back pain. There is no consensus regarding the treatment efficacy of facet joint radiofrequency denervation (FJRD) and how it compares with nerve blockades and joint infiltration with anesthetics and/or corticosteroids. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and LILACS for randomized controlled trials that compared FJRD with blockades, infiltrations, or placebo. Primary outcomes were pain, functional status, and quality of life. Secondary outcomes were cost-effectiveness and complications. Fifteen studies were selected and 9 were eligible. Overall quality of evidence was rated low to moderate. The evidence favored FJRD regarding pain control. There was no sufficient evidence for cost-effectiveness and complications. The available evidence reviewed in this study should be interpreted with caution. The data indicate that FJRD is more effective than placebo in pain control and functional improvement and is also possibly more effective than steroid injections in pain control. Complications and adverse effects were not sufficiently reported to allow comparisons, and there was no evidence for cost-effectiveness. High-quality randomized controlled trials addressing pain, function, quality of life, complications, and cost-effectiveness are urgently needed. 1.

Identifying Patients With Chronic Low Back Pain Likely to Benefit From Lumbar Facet Radiofrequency Denervation

Case series. Prospective study. This is a prospective study of a group of patients with chronic low back facet joint pain, meticulously selected using a combination of clinical history, examination, imaging tests, and lumbar facet joint block with a local anesthetic, aimed at assessing the efficacy of treatment with percutaneous rhizolysis in reducing pain and improving related disability. Percutaneous radiofrequency facet joint denervation (rhizolysis) provides significant alleviation of pain and functional disability in patients with chronic low back pain of facet joint origin. However, accurate patient selection represents a clinical challenge. Patient selection based only on the result of diagnostic blocks may lead to disappointing results as the false-positive rate of the anesthetic diagnostic blocks is reported to be more than 30%. A total of 86 patients (mean age, 49.87; mean duration of pain, 7.12 y) finally selected for treatment with rhizolysis were those who presented with chronic lumbar pain and a clinical history and examination with characteristics specific to facet joint pain; whose imaging tests ruled out a possible origin of pain other than the facet joints; and who finally responded favorably to facet joint block with a local lumbar anesthetic. All patients were clinically evaluated according to the indications of the Spanish Society for the Study of Diseases of the Spine (GEER). A follow-up of a minimum of 1 year was conducted. After rhizolysis, lumbar pain, measured by the visual analog scale and the Oswestry Low Back Pain Disability Questionnaire, improved significantly (P<0.05), with the reduction in disability due to lumbar pain being reflected in a notable improvement in the patients' quality of life. A total of 89% of patients experienced significant relief from pain after rhizolysis, with this relief lasting 6 months or more in 66%, and a minimum of 1 year in 50% of cases. At 1 year, 75.67% of patients stated that they would willingly undergo the same treatment again. Rhizolysis is a valuable tool for the symptomatic treatment of chronic lumbar facet joint pain. A meticulous selection of patients using a combination of clinical history, examination, imaging tests, and lumbar facet joint block with a local anesthetic, achieves long-lasting results by helping reduce the impact on these patients' daily activities.

Comprasion of Effectiveness of CT vs C-arm Guided Percutaneous Radiofrequency Lumbar Facet Rhizotomy

BackgroundFacet joint have been implicated as a source of chronic low back pain. Radiofrequency denervation has demonstrated the most solid evidence. To increase safety and efficacy of treatment, computed tomography (CT) guidance injection has been used in several disease. The purpose of this study was to evaluate the efficacy of CT-guided radiofrequency rhizotomy in the treatment of facet joint pain.MethodsA total of 40 patients were randomized to undergo radiofrequency facet joint denervation under CT guidance or C-arm guidance. All patients were examined visual analogue scale (VAS) score before treatment, 1 month, and 3 months after treatment.ResultsThe VAS in both groups showed significant improvement over the 1-month interval. No significant difference in the VAS score among the group was observed.ConclusionsIn this study there was no significant difference between CT guidance lumbar rhizotomy and C-arm guidance lumbar rhizotomy. Therefore CT-guided radiofrequency denervation of the lumbar facet joint was a minimally invasive technique that appears effective.

Repeat Percutaneous Radiofrequency Facet Joint Denervation for Chronic Back Pain: A Prospective Study

ABSTRACTObjective: To investigate whether repeat lumbar percutaneous radiofrequency facet joint denervation [RFJD] is an efficacious ongoing treatment for chronic low back pain [LBP] using the Low Back Outcome Score [LBOS] and subjective measures of patient satisfaction.Methods: A prospective open-label, single intervention study was carried out on a consecutive series of patients undergoing repeat lumbar RFJD performed by a single operator in 2007. Patients with an initially successful RFJD procedure were selected for the study excluding patients with greater than four procedures in total. Lumbar medial branch neurotomy was conducted using a 20-gauge silicone-coated probe inserted under fluoroscopic control and neuroleptic intravenous sedation with radiofrequency thermal energy applied for 90 seconds per joint at a maximum probe tip temperature of 90°C. The patients completed a LBOS questionnaire before and 12 months following the repeat RFJD procedure. They were also asked about their satisfaction with ...

MRI Analysis of the Lumbar Spine: Can It Predict Response to Diagnostic and Therapeutic Facet Procedures?

To determine the correlation between magnetic resonance imaging (MRI) pathology and the response to diagnostic facet medial branch block (MBB) and L5 dorsal ramus medial branch block and radiofrequency (RF) denervation of lumbar facet joints. The medical records of 127 consecutive patients who underwent MBB for suspected zygapophysial joint pain were reviewed. The lumbar spine MRI of these patients was systematically graded by 2 musculoskeletal radiologists for loss of disc height, spinal stenosis, facet joint degeneration, and other forms of spinal pathology. Patients with central or foraminal spinal stenosis had statistically significant correlation with positive outcome of RF (P=0.02), but not with MBB (P=0.08). The presence of facet joint degeneration or hypertrophy was positively correlated with response to MBB (71% vs. 51%; P=0.04), but not RF. Loss of disc height did not correlate with outcome of MBB (P=0.08) and RF (P=0.29). For other spinal pathology, no significant differences were noted for either the response to diagnostic blocks or the RF denervation. Younger patients were more likely to fail MBB (P<0.01) but not RF denervation (P=0.38). Whereas some relationships were noted between MRI findings and the response to lumbar facet joint interventions, many of these correlations tended to be weak. However, this study does suggest the possibility that patients with spinal stenosis, often considered an exclusion criterion for facet interventions, may respond to RF denervation of facet joints. Prospective studies are needed to confirm these observations.

A Prospective Outcome Study on the Effects of Facet Joint Radiofrequency Denervation on Pain, Analgesic Intake, Disability, Satisfaction, Cost, and Employment

A Prospective Outcome Study on the Effects of Facet Joint Radiofrequency Denervation on Pain, Analgesic Intake, Disability, Satisfaction, Cost, and Employment

A Prospective Outcome Study on the Effects of Facet Joint Radiofrequency Denervation on Pain, Analgesic Intake, Disability, Satisfaction, Cost, and Employment

Burnham RS, Holitski S, Dinu I. A prospective outcome study on the effects of facet joint radiofrequency denervation on pain, analgesic intake, disability, satisfaction, cost, and employment. Objective To assess the effect of radiofrequency denervation (RFD) on patients with chronic low back pain (LBP) of facet joint origin. Design Prospective cohort study. Setting Interventional pain management program. Participants Consecutive subjects (N=44; 101 facet joints) over 2 years with chronic refractory mechanical LBP of facet origin established by 2 local anesthetic blocks (medial branch ± intra-articular) resulting in more than 50% pain relief. Intervention RFD of the symptomatic lumbar facet joints. Main Outcome Measures Self-reported pain intensity, frequency, bothersomeness, analgesic intake, satisfaction, disability, back pain–related costs, and employment twice prior to and at 1, 3, 6, 9, and 12 months post-RFD. Results Post-RFD, significant improvements in pain, analgesic requirement, satisfaction, disability, and direct costs occurred. They peaked at 3 to 6 months and gradually diminished thereafter. Satisfaction with medical care and living with current symptoms improved similarly. Overall, satisfaction with the RFD procedure was high, and no complications were reported. Conclusions RFD provides safe and significant short-term improvement in pain, analgesic requirements, function, satisfaction, and direct costs in patients with chronic LBP of facet origin.

Radiofrequency Denervation of Lumbar Facet Joints in the Treatment of Chronic Low Back Pain

Radiofrequency facet joint denervation procedures have been common practice for 2 decades in treatment of chronic low back pain. We designed this multicenter, randomized, double-blind, sham treatment controlled trial to determine the efficacy of radiofrequency facet joint denervation, as it is routinely performed. Inclusion criteria were low back pain, duration more than 6 months, and >or=50% Visual Analog Scale (VAS) reduction on diagnostic block. Exclusion criteria were prior radiofrequency treatment, radicular syndrome, coagulopathies, specific allergies, cancer, and pregnancy. A total of 81 out of 462 patients were randomized to undergo radiofrequency facet joint denervation or sham treatment. The first evaluation was carried out 3 months after treatment. Primary outcome was determined with a combined outcome measure comprising VAS, physical activities, and analgesic intake, from a twice-weekly recorded diary. Secondary outcome measures were the separate diary parameters, global perceived effect (complete relief, >50% relief, no effect, pain increase), and SF-36 Quality of Life Questionnaire. There were no dropouts before the first evaluation. The combined outcome measure showed no differences between radio- frequency facet joint denervation (n=40; success 27.5%) and sham (n=41; success 29.3%) (P=0.86). The VAS in both groups improved (P<0.001). Global perceived effect improved after radiofrequency facet joint denervation (P<0.05). The other secondary outcome parameters showed no significant differences. Relevant costs were evaluated. The combined outcome measure and VAS showed no difference between radiofrequency and sham, though in both groups, significant VAS improvement occurred. The global perceived effect was in favor of radiofrequency. In selected patients, radiofrequency facet joint denervation appears to be more effective than sham treatment.

Complications of lumbar facet radiofrequency denervation.

Retrospective. To assess the incidence of complications associated with fluoroscopically guided percutaneous radiofrequency denervation of the lumbar facet joints. Based on the results of previous efficacy studies, complications associated with facet joint radiofrequency denervation procedures appear to be rare. No formal safety assessment for this procedure has been performed to date. We conducted retrospective chart reviews to identify complications that occurred within 8 weeks of facet joint radiofrequency denervation procedures performed at the Mayo Clinic in Jacksonville during a 5-year period. Only procedures that included radiofrequency electrode placement between the L1 transverse process and the sacral ala were included. The chart of each patient was reviewed and adjudicated by a panel of 4 physicians before being classified as a complication. Ninety-two patients received a total of 616 radiofrequency lesions during 116 separate denervation procedures. An average of 5 +/- 3 lesions were performed during each radiofrequency denervation procedure. Six minor complications were identified, yielding a 1.0% overall incidence of minor complications per radiofrequency site. Complications included: 3 cases of localized pain lasting more than 2 weeks (0.5%) and 3 cases of neuritic pain lasting less than 2 weeks (0.5%). No cases of infection, new motor deficits, or new sensory deficits were identified. Fluoroscopically guided percutaneous radiofrequency denervation of the lumbar facets is associated with an overall 1.0% incidence of minor complications per lesion site.