Radiofrequency Neurotomy Research Articles

C0-C1 joint injection: Anatomical, clinical and technical review

BackgroundCervicogenic headaches (CGH) are proven clinical entities. The prevalence of CGH arising from the atlanto-occipital (AO) joint is unknown. The best evidence for treatment of CGH is for third occipital nerve radiofrequency neurotomy. Treatment of CGH includes intra-articular injections into upper cervical spine joints. ObjectiveTo perform a review of the anatomy and clinical presentation of AO joint (AOJ) pain referral as well as a technical description to safely access the AOJ. MethodsA literature review was performed to explore the intricacies of the cranio-cervical junction (CCJ) with a focus on the relation between the AOJ and vascular anatomy. Our technical approach is described with complementary images. ResultsThe AOJ lies anterior to a venous sinus and slightly superior to the horizontally oriented vertebral artery crossing the joint line. ConclusionThe authors propose a modified superior needle trajectory that seeks to avoid these vascular structures and to access the AOJ safely.

A description and outcome evaluation of sacrococcygeal joint radiofrequency neurotomy for treatment of chronic coccydynia – A dorsal approach

BackgroundCoccydynia is a condition characterized by pain and tenderness in the coccyx region of the spine. Chronic coccydynia (≥3-months) management remains a clinical challenge. Radiofrequency neurotomy (RFN) targeting the sacrococcygeal joint (SCJ) and/or 1st intercoccygeal joint (ICJ) margins has emerged as an alternative, minimally invasive intervention for refractory coccydynia. ObjectiveThe objective of this study was to evaluate the safety and effectiveness of an RFN technique targeting the dorsal aspect of SCJ and/or 1st ICJ for treatment of patients with chronic coccydynia. MethodsRetrospective analysis of prospective outcomes for patients with chronic coccydynia (≥3-months) who underwent RFN to dorsal SCJ and/or 1st ICJ between 2009 - 2023. RFN technique was a dorsal approach targeting the distal sacrum and proximal coccyx, which form the SCJ or 1st ICJ margins. Numerical rating scale (NRS) and Pain Disability Quality-of-Life Questionnaire-Spine (PDQQ-S) scores were completed pre- and 3-months post-RFN. Successful RFN was defined as ≥50% reduction or minimal clinical important difference (MCID) in PDQQ-S and NRS pain scores. The primary outcome measures were the proportion of patients achieving ≥50% reduction in NRS pain and PDDQ-S scores following primary and repeat RFN to SCJ and/or 1st ICJ. Secondary outcomes included the proportion of patients achieving MCID on NRS pain and PDQQ-S scores following RFN, as well as mean NRS and PDQQ-S scores pre- and 3-months post-RFN, and magnitude of improvement for patients following successful RFN procedures. ResultsA total of 52 RFN procedures (n = 30 primary, and n = 22 repeat procedures) were performed on 30 patients (female = 25, male = 5, mean age 55.1 ± 13.0yrs). Ten patients (33.3%; 95% CI = 17.3–52.8) reported ≥50% pain reduction as measured by NRS pain and PDQQ-S scores following primary SCJ and/or 1st ICJ RFN at 3-months follow-up. Fifteen patients (50%; 95% CI = 31.3–68.7) reported MCID NRS pain reduction and 12 patients (40.0%; 95% CI = 22.7–59.4) reported MCID PDQQ-S scores at 3-months following primary RFN. The mean magnitude of improvement for patients with primary successful RFN, as defined as ≥50% reduction in either NRS pain or PDQQ-S scores, was 77.4% (±SD 21.4%) and 74.9% (±SD = 19.9%), respectively. Similarly, the mean magnitude of improvement for patients with successful RFN, as defined by MCID reduction in NRS pain or PDQQ-S scores, was 62.6% (±SD = 28.2%) and 69.3% (±SD = 22.3%), respectively. At 3-months follow-up, 14 patients (63.6%; 95% CI = 40.7–82.8) reported ≥50% pain reduction as measured by either NRS pain and PDQQ-S scores following repeat RFN. Nineteen patients (86.4%; 95% CI = 65.1–97.1) reported MCID NRS pain reduction and 16 patients (72.7%; 95% CI = 49.8–89.3) reported MCID PDQQ-S scores at 3-months following repeat RFN. Statistically significant differences were observed between pre- and post-RFN NRS pain and PDQQ-S scores (p < 0.005) in both primary and repeat procedures. Discussion/conclusionThis study represents an introductory step in evaluating the efficacy of a dorsal approach RFN technique targeting the SCJ and/or 1st ICJ as a treatment option for chronic coccydynia. Primary RFN demonstrated pain reduction and improvement in function at 3-months in 33.3% of patients. Several limitations remain, including heterogeneity in patient population, small sample size, and no control groups. Future detailed investigations include cadaveric studies to clarify sensory innervation and enhance reliability of our targets during RFN. Larger prospective studies of long-term outcomes, including comparison with control groups, are required to further evaluate the efficacy of our dorsal RFN approach.

Can ultrasound-guided medial branch blocks be used to select patients for cervical facet joint radiofrequency neurotomy? A matched retrospective cohort validation study

Abstract Background Medial branch blocks are used to select patients for cervical facet joint radiofrequency neurotomy (CRFN). Blocks are typically performed under fluoroscopic guidance (ie, fluoroscopy-guided blocks [FLBs]). The validity of ultrasound-guided blocks (USBs) is not well established. No prior research has compared cervical USB validity and FLB validity with CRFN outcome used as the criterion standard. Objective To evaluate cervical USB versus FLB validity with CRFN outcome used as the criterion standard. Methods Demographic and outcome data were extracted from the electronic medical records of 2 affiliated musculoskeletal pain management clinics for all patients between 2015 and 2023 inclusive who had cervical USB leading to CRFN. CRFN outcomes of each USB patient were compared with those of a matched FLB patient from the radiofrequency neurotomy (RFN) outcome database of the same clinics. Matching variables included patient age, sex, pain duration, diagnostic/prognostic block paradigm, and CRFN number. Each patient completed a numeric rating scale (NRS) pain score and Pain Disability Quality-of-Life Questionnaire (PDQQ) just before and 3 months after CRFN. At repeat CRFN, patients provided a retrospective estimate of the duration and average magnitude (percentage) of relief after the CRFN. Results USB and FLB groups were comprised of 27 patients (58 RFNs) and 38 patients (58 RFNs), respectively. Post-RFN NRS pain severity and PDQQ-Spine scores demonstrated comparable (P &amp;gt; .05) absolute improvements, proportion of patients achieving ≥50% improvement, and attainment of the minimum clinically important difference. Retrospective estimates of pain relief magnitude and duration were also comparable. Conclusions This study finds cervical USB and FLB to be comparably valid as defined by their ability to predict CRFN outcome. Within the limitations of operator competence, USB can be used to select patients for CRFN.

True lateral imaging during lumbar medial branch radiofrequency neurotomy: Interobserver reliability

BackgroundTrue lateral imaging (TLI), obtained by superimposing bilateral lumbar spine structures and aligning superior endplate cortical bone, requires deliberate rotational adjustments of the laterally positioned fluoroscope in both the axial and longitudinal planes. True lateral segmental imaging is necessary to depict true and accurate radiofrequency (RF) cannula positioning relative to bony anatomy during lumbar medial branch radiofrequency neurotomy (LMBRFN). ObjectiveTo determine the interobserver reliability of TLI during LMBRFN. MethodsThis was a retrospective review of a prospectively generated collection of lateral fluoroscopic images to determine the interobserver reliability of TLI during LMBRFN. Lateral fluoroscopic images were prospectively collected from 34 consecutive L4-5 and L5-S1 LMBRFN procedures during routine clinical practice. Employing International Pain and Spine Intervention Society (IPSIS) LMBRFN and TLI techniques, an RF cannula was positioned parallel to the L3 and L4 medial branches and the L5 dorsal rami. During the normal course of TLI, untrue and final true lateral segmental images were obtained and saved. An original data set of 100 pairs of true and untrue lateral images was reviewed to verify true laterality using established criteria; disagreement was resolved by consensus or discarding ambiguous cases. To measure interobserver reliability (Cohen's Kappa), two blinded expert reviewers independently reviewed the image set, identifying the true lateral image and the plane requiring correction. ResultsThe observers agreed upon 98/98 true lateral RF-segment images (Kappa score 1.0 [1.00,1.00]). The observers agreed upon 86/98 maneuvers to correct the untrue RF-segment image. The Kappa score for determining the most appropriate corrective maneuver was 0.76 (0.63,0.89), showing substantial interobserver agreement. ConclusionsThe true lateral image of the targeted RF segment during LMBRFN was reliably determined with perfect interobserver agreement. Interobserver agreement was substantial regarding the maneuver to achieve TLI.

Effective Management of Recurrent Trauma-Induced Neck Pain With Radiofrequency Neurotomy Using the Nimbus Electrosurgical Radiofrequency Multitined Expandable Electrode: A Case Report

BACKGROUND: Radiofrequency neurotomy (RFN) can be an effective treatment for patients with chronic neck pain and cervicogenic headaches resistant to conservative care. However, the degree and duration of pain relief after RFN is dependent upon the thoroughness of target nerve coagulation. CASE REPORT: This is a case of a 37-year-old patient with debilitating neck pain and headaches following a motor vehicle accident. Successful local anesthetic block of the third occipital nerve (TON) confirmed pain of C2-C3 facet joint origin. An initial RFN treatment of the TON, using standard 18G electrodes in bipolar mode, resulted in complete symptom amelioration for 8 months. Repeat RFN, using the same electrode configuration, was unsuccessful in alleviating the severe neck pain and headaches, and produced no demonstrable sensory loss in the distribution of the TON. RFN was then performed using the Nimbus® electrosurgical RF multitined expandable electrode, which provides a larger zone of coagulation in volume than standard RFN electrodes even when used in bipolar configuration. CONCLUSIONS: The Nimbus procedure resulted in successful coagulation of the TON with sensory loss in the TON distribution and reinstatement of palliative relief. KEY WORDS: Cervical pain, radiofrequency neurotomy, third occipital nerve, Nimbus, case report

The association of payer type on genicular radiofrequency neurotomy treatment outcomes: Results of a cross-sectional study

BackgroundGenicular radiofrequency neurotomy (GRFN) is an effective treatment for a subset of individuals with chronic knee pain. Previous studies demonstrate that Medicare and Medicaid beneficiaries report worse outcomes following various interventional procedures compared with commercially insured patients. ObjectiveEvaluate the association of payer type on GRFN treatment outcomes. MethodsConsecutive patients who underwent GRFN at a tertiary academic center were contacted for participation. Demographic, clinical, and procedural characteristics were collected from electronic medical records. Outcome data were collected by standardized telephone survey at 6–12 months, 12–24 months and ≥24 months. Treatment success was defined as ≥50% numerical pain rating scale (NPRS) score reduction from baseline. Data were analyzed using descriptive statistics for demographic, clinical, and procedural characteristics. Logistic and Poisson regression analyses were performed to examine the association of variables of interest and pain reduction. ResultsOne hundred thirty-four patients treated with GRFN (mean 65.6 ± 12.7 years of age, 59.7% female) with a mean follow-up time of 23.3 ± 11.3 months were included. Payer type composition was 48.5% commercial (n = 65), 45.5% Medicare (n = 61), 3.7% Medicaid (n = 5), 1.5% government (n = 2), and 0.8% self-pay (n = 1). Overall, 47.8% of patients (n = 64) reported ≥50% NPRS score reduction after GRFN. After adjusting for age, follow-up duration, Kellgren-Lawrence osteoarthritis grade, baseline opioid use, antidepressant/antianxiety medication use, history of knee replacement, and number of RFN lesions placed, the logistic regression model showed no statically significant association between payer type and treatment outcome (OR = 2.11; 95% CI = 0.87, 5.11; p = 0.098). Discussion/conclusionIn this study, after adjusting for demographic, clinical, and procedural characteristics, we found no association between payer type and treatment success following GRFN. This observation contrasts findings from other interventional studies reporting an association between payer category and treatment success.

Asymmetrical atrophy of the paraspinal muscles in patients undergoing unilateral lumbar medial branch radiofrequency neurotomy.

Lumbar medial branch radiofrequency neurotomy (RFN), a common treatment for chronic low back pain due to facet joint osteoarthritis (FJOA), may amplify paraspinal muscle atrophy due to denervation. This study aimed to investigate the asymmetry of paraspinal muscle morphology change in patients undergoing unilateral lumbar medial branch RFN. Data from patients who underwent RFN between March 2016 and October 2021 were retrospectively analyzed. Lumbar foramina stenosis (LFS), FJOA, and fatty infiltration (FI) functional cross-sectional area (fCSA) of the paraspinal muscles were assessed on preinterventional and minimum 2-year postinterventional MRI. Wilcoxon signed-rank tests compared measurements between sides. A total of 51 levels of 24 patients were included in the analysis, with 102 sides compared. Baseline MRI measurements did not differ significantly between the RFN side and the contralateral side. The RFN side had a higher increase in multifidus FI (+4.2% [0.3-7.8] vs +2.0% [-2.2 to 6.2], P = 0.005) and a higher decrease in multifidus fCSA (-60.9 mm 2 [-116.0 to 10.8] vs -19.6 mm 2 [-80.3 to 44.8], P = 0.003) compared with the contralateral side. The change in erector spinae FI and fCSA did not differ between sides. The RFN side had a higher increase in multifidus muscle atrophy compared with the contralateral side. The absence of significant preinterventional degenerative asymmetry and the specificity of the effect to the multifidus muscle suggest a link to RFN. These findings highlight the importance of considering the long-term effects of lumbar medial branch RFN on paraspinal muscle health.

Investigation of the anatomical course of articular branches to the thoracic zygapophysial joints

BackgroundRecent studies have questioned the validity of targeting the thoracic medial branch via anesthetic blocks or radiofrequency neurotomy for the diagnosis or treatment of pain from the thoracic zygapophysial joints. PurposeTo define the origin and course of the articular branches to the thoracic zygapophysial joints at all levels. DesignCadaveric dissection. SettingThe Gross Anatomy Laboratory at the University of New England College of Osteopathic Medicine. SubjectsOne cadaveric thoracic spine. MethodsGross and stereoscopic dissection of the bilateral dorsal rami T1–T12 was performed on one embalmed cadaver. The medial and lateral branches were traced from their cutaneous distribution to the origin at the dorsal ramus. The articular branches were identified using stereoscopic dissection by tracing their origin from the dorsal ramus or medial branch to the capsule of the zygapophysial joint. The images were recorded using digital photography. ResultsTwenty-two of the twenty-four articular branches were identified in a single cadaveric specimen. Articular branches at T7 on the right side and T9 on the left side were not identified. 5 of the 22 (18%) articular branches were observed to arise from the proximal segment of the medial branch of the dorsal ramus. Of the remainder, 17 of the 22 (78%) articular branches were observed to arise from the dorsal primary ramus itself. At levels T1-9, the articular branch coursed inferiorly along the lamina to reach the joint capsule. At levels T10-T12, the articular branch traversed the intervertebral foramen to reach the facet joint. The T12 medial branch on the left was seen to travel inferior to innervate the L1/L2 zygapophysial joint. ConclusionThe source of the innervation for the thoracic zygapophysial is variable and can arise from the dorsal ramus itself or from the proximal segment of the medial branch. Unlike the cervical and lumbar medial branches, which innervate two joints each, in this case, the thoracic dorsal rami appear to innervate only the zygapophysial joint at the level of the nerve exit. It should be noted that the findings may be limited in their generalizability due to the reliance on a single cadaver study.

End-on versus parallel radiofrequency lesioning for neurotomy of the cervical medial branch nerves: a study protocol of a prospective, randomized, double-blind clinical trial: the “EndPaRL” study

BackgroundCervical facet joint disease is a common source of neck pain and its prevalence increases with aging. Conservative multimodal management options (e.g., strengthening of neck muscles, non-steroidal anti-inflammatory medications, massage, and thermal modalities) often fail to relieve pain. Cervical medial branch nerve (CMBN) radiofrequency neurotomy (RFN) is an effective minimally invasive technique for treating chronic neck pain secondary to facet joint disease. An end-on approach for this procedure has been proposed that may be technically easier and require less time while reducing post-procedural discomfort. The protocol presented here is for a study that aims to compare the efficacy of a new end-on approach using multi-tined cannulae, against the conventional parallel technique that employs straight cannulae for RFN of the CMBN in patients with chronic neck pain due to cervical facet joint disease.MethodsA multicentre randomized, non-inferior, active comparator-controlled trial will be conducted with two parallel groups and blinding of participants and outcome assessor. The study will include 72 adults with chronic neck pain secondary to facet joint disease who are candidates for RFA of the CMBN. Participants will be randomized to either the conventional parallel or the end-on approach in a 1:1 ratio. The intensity of pain and pain-related domains (function, quality of life, sleep, adverse effects of the interventions, analgesic intake) will be measured at 1, 3, 6, and 12 months after the procedure.DiscussionNeck pain secondary to cervical facet joint disease is prevalent and RFA of the CMBN is a validated treatment for relieving it. The conventional parallel technique can be technically challenging, and it can be associated with adverse effects while the newer end-on approach has the potential of being a simpler technique with less adverse effects. This trial will be the first non-inferiority study to compare the clinical efficacy of the end-on approach against the conventional parallel approach for RFN of CMBN in patients with chronic neck pain due to cervical facet joint disease.Trial registrationClinicalTrials.gov NCT05818774. Registered on April 20, 2023.

Does medial branch radiofrequency neurotomy accelerate degenerative lumbar spondylolisthesis compared to natural progression? A cross-sectional cohort study

BackgroundLumbar radiofrequency neurotomy (LRFN) effectively treats lumbar zygapophyseal joint pain by coagulating medial branch nerves (MBNs) carrying nociceptive signals. MBNs also innervate deep paraspinal muscles. There is a paucity of literature on whether LRFN accelerates the progression of vertebral displacement in patients with degenerative lumbar spondylolisthesis (DLS). ObjectiveCompare the rate of spondylolisthesis progression in adults with DLS who underwent LRFN to the 2% annual rate of progression expected by natural history. DesignCross-sectional cohort study. MethodsConsecutive patients with pre-existing DLS who underwent LRFN for zygapophyseal joint-mediated low back pain were identified. Patient demographics, LRFN procedure details, and radiographic images confirming Meyerding Grade (I-II) spondylolisthesis were collected from electronic medical records. The quantitative magnitude of spondylolisthesis progression and the annualized rate were calculated from pre-and post-LRFN radiographs. Data were analyzed using Wilcoxon signed-rank tests and a linear regression model. Results152 patients (mean age 65.9 ± 12.3 years; 59.2% female) met eligibility criteria and were included in the analyses. Average time to radiographic follow-up was 35.6 ± 24.7 months post-LRFN. The average spondylolisthesis progression rate of 1.63 ± 2.91% per year calculated for the LRFN cohort was significantly lower than the 2% annual rate of progression associated with natural history (p < 0.001). None of the included covariates, such as age, BMI, LRFN laterality, number of levels denervated, or history of prior lumbar spinal surgery, were significantly associated with the average annual rate of progression. ConclusionsOur results suggest that spondylolisthesis progression rate is no different or worse than the expected natural progression rate in patients with pre-existing DLS who have undergone LRFN.

The Effectiveness of Medial Branch Blocks and Radiofrequency Neurotomy in Managing Chronic Thoracic Pain: A Systematic Review and Meta-Analysis

BACKGROUND: Extensive research into potential sources of thoracic pain with or without referred pain into the chest wall has demonstrated that thoracic facet joints can be a potential source of pain confirmed by precise, diagnostic blocks. The objective of this systematic review and meta-analysis is to evaluate the effectiveness of medial branch blocks and radiofrequency neurotomy as a therapeutic thoracic facet joint intervention. METHODS: Systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies of medial branch blocks and the radiofrequency neurotomy in managing thoracic pain utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist was performed. A comprehensive literature search of multiple databases of RCTs and observational studies of medial branch blocks and radiofrequency neurotomy in managing chronic thoracic pain were identified from 1996 to December 2022 with inclusion of manual searches of the bibliography of known review articles and multiple databases. Methodologic quality and risk of bias assessment was also conducted. Evidence was synthesized utilizing principles of quality assessment and best evidence synthesis, with conventional and single meta-analysis. The primary outcome measure of success was 3 months of pain reduction for medial branch blocks and 6 months for radiofrequency thermoneurolysis for a single treatment. Short-term success was defined as up to 6 months and long-term was more than 6 months. RESULTS: This literature search yielded 11 studies meeting the inclusion criteria, of which 3 were RCTs and 8 were observational studies. Of the 3 RCTs, 2 of them assessed medial branch blocks and one trial assessed radiofrequency for thoracic pain. The evidence for managing thoracic pain with qualitative analysis and single-arm meta-analysis and GRADE system of appraisal, with the inclusion of 2 RCTs and 3 observational studies for medial branch blocks was Level II. For radiofrequency neurotomy, with the inclusion of one RCT of 20 patients in the treatment group and 5 observational studies, the evidence was Level III in managing thoracic pain. LIMITATIONS: There was a paucity of literature with RCTs and real-world pragmatic controlled trials. Even observational studies had small sample sizes providing inadequate clinically applicable results. In addition, there was heterogeneity of the available studies in terms of their inclusion and exclusion criteria, defining their endpoints and the effectiveness of the procedures. CONCLUSION: This systematic review and meta-analysis show Level II evidence of medial branch blocks and Level III evidence for radiofrequency neurotomy on a long-term basis in managing chronic thoracic pain. KEY WORDS: Chronic spinal pain, thoracic facet or zygapophysial joint pain, facet joint nerve blocks, medial branch blocks, controlled comparative local anesthetic blocks, diagnostic accuracy, radiofrequency neurotomy

The effectiveness and predictive factors of Sacroiliac Joint Radiofrequency Neurotomy success – A retrospective cohort study

BackgroundThe Sacroiliac Joint (SIJ) accounts for 10–27% of lower back pain. Radiofrequency neurotomy (RFN) is commonly utilized for refractory pain. Outcomes are variable and may be related to patient selection and procedural technique differences. ObjectiveTo assess the effectiveness and outcome success predictors of SIJ RFN at three months. Design/MethodsData of patients undergoing SIJ RFN were extracted from the electronic medical record of one physiatrist's interventional pain practice between 2016 and 2021. The extracted data included the following outcome variables: ≥2 decrease in Numerical Rating Scale (NRS) [minimal clinically important difference MCID-2], ≥50% NRS reduction, and ≥17 points decrease in the Pain Disability and Quality of Life Questionnaire – Spine (PDQQ-S) [MCID]. Predictor variables included block type [>79% LBB/LBB, >79% IA/LBB, 50–79% LBB/LBB, 50–79% IA/LBB, >79% LBB, and 50–79% LBB] and cannula type/configuration [16 g/longitudinal, Trident bipolar/perpendicular, and 18 g quadripolar/perpendicular]. Data analysis included descriptive statistics and logistic regression with an odds ratio (OR). Covariates included in the logistic regression models were age, gender, and laterality (right, left, and bilateral). ResultsOf the 128 patients analyzed for this study (20.8% males; 60.4 ± 14.4 years of age), 66.9% achieved MCID-2 in NRS, 53.9% experienced ≥50% NRS reduction, and 50% experienced ≥17 points decrease in PDQQ-S. Achieving MCID-2 in NRS for the 18 g quadripolar/perpendicular technique was approximately four times higher than the odds for 16 g/longitudinal technique (OR = 3.91; 95% CI = 1.34–11.43; p = 0.013). Block type was not significantly associated with any outcome variable after adjusting for cannula type and other covariates (p > 0.05). Younger age was significantly associated with achieving MCID-2 in NRS, ≥50% NRS reduction, and ≥17 points decrease in PDQQ (p = 0.034, 0.020, and 0.002, respectively). ConclusionSIJ RFN effectively reduces pain and improves function in most patients at three months. Quadripolar/perpendicular technique and younger age predict SIJ RFN treatment success, whereas block type does not.

Randomized controlled trial comparing technical features and clinical efficacy of a multi-tined cannula versus a conventional cannula for cervical medial branch radiofrequency neurotomy in chronic neck pain

ObjectivesCompare procedural characteristics and clinical efficacy of cervical medial branch radiofrequency neurotomy (CMBRFN) using a multi-tined cannula (MTC) versus a conventional cannula (CC) to treat chronic neck pain. DesignProspective, double-blinded randomized controlled trial. MethodsPatients who responded to dual medial branch blocks with ≥75% pain relief were randomized to receive RFN with either the MTC or the CC. Primary outcomes: procedural pain, procedure duration, fluoroscopy time and radiation dose. Secondary outcomes: proportion of patients reporting ≥50% numerical rating scale reduction and ≥30% neck disability index reduction at 3, 6 and 12 months. ResultsForty-two patients underwent treatment. There was no difference in procedural pain between the MTC and CC groups (NRS 4.7 ± 2.0 vs. 4.2 ± 1.8, p = 0.465), but three patients, all in the CC group, could not complete the procedure due to pain. CMBRFN in the MTC group was significantly faster than in the CC group (35.5 ± 7.3 min vs. 58.2 ± 14.8 min, p < 0.001), with less fluoroscopy time (167.6 ± 76.4 s vs. 260.8 ± 123.5 s, p = 0.004). Radiation dose was 8.95 ± 7.9 mGy in the MTC group and 11.53 ± 10.3 mGy in the CC group (p = 0.36). Rates of ≥50% NRS reduction were not significantly different between the two groups at 3 months, but at 6 and 12 months, they were significantly higher in the CC group. At 3, 6 and 12 months, rates of ≥30% NDI reduction were significantly higher in the CC group. ConclusionsThe MTC offers technical advantages compared to the CC for both the operator and the patient. However, CMBRFN with the multi-tined cannula seems less effective to treat neck pain than with the conventional cannula.

The Invasive Management of Pain: Diagnosis and New Treatment Options.

Both the diagnosis and treatment of pain are evolving, especially in interventional approaches. Diagnosis of low back pain combines old and new methodologies, in particular, it involves an expanded role for ultrasound. While low back pain is a common complaint, there are many etiologies to the conditionwhich must be explored before a final diagnosis can be made and treatment planned. Tumors and infections are rarely involved in low back pain but should be ruled out in the initial phase itself since failing to address them early can have devastating consequences. Some invasive treatments seem promising in the management of low back pain. Treating musculoskeletal pain with regenerative medicine, such as platelet-rich plasma, holds great promise. Autologous blood products are safe and may help stimulate the body's own responses for regeneration. The so-called "orthobiologics" play a role in sports medicine and the treatment of musculoskeletal pain. Neuromodulation, especially spinal cord stimulation, is undergoing a renaissance with new waveforms, devices, and a greater albeit incomplete understanding of its mechanisms of action. Spinal cord stimulation is not a first-line therapy and not all patients or all back problems respond to this treatment. Nevertheless, the therapy can be safe, effective, and cost-effective with appropriate patient selection. Radiofrequency ablation of nerves in the form of neurotomy can be effective in reducing the pain of osteoarthritis. These procedures, including the newer cooled radiofrequency neurotomy, can restore function, reduce pain, and may potentially have an opioid-sparing effect. Technical expertise in nerve and anatomy is needed for the use of this technique. This review article aims to provide updated information on some invasive intervention techniques in pain management.

Commentary on the article "Radiofrequency Neurotomy Does Not Cause Fatty Degeneration of the Lumbar Paraspinal Musculature in Patients with Chronic Lumbar Pain-A Retrospective 3D-Computer-Assisted MRI Analysis Using iSix Software" by Oswald et al.

Journal Article Accepted manuscript Commentary on the article “Radiofrequency Neurotomy Does Not Cause Fatty Degeneration of the Lumbar Paraspinal Musculature in Patients with Chronic Lumbar Pain—A Retrospective 3D-Computer-Assisted MRI Analysis Using iSix Software” by Oswald et al Get access Min Cheol Chang Min Cheol Chang Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea Corresponding Author: Min Cheol Chang, MD, Department of Physical Medicine & Rehabilitation, College of Medicine, Yeungnam University, 170 Hyeonchung-ro, Nam-gu, Daegu, 42415, Republic of Korea, Tel: +82-53-620-3270, e-mail: wheel633@gmail.com. Search for other works by this author on: Oxford Academic PubMed Google Scholar Pain Medicine, pnad083, https://doi.org/10.1093/pm/pnad083 Published: 20 June 2023 Article history Received: 03 March 2023 Accepted: 15 June 2023 Published: 20 June 2023

FactFinders for patient safety: Understanding potential procedure-related complications: RFN/multifidus atrophy, intradiscal biologics, and facet cyst rupture

This series of FactFinders presents a brief summary of the evidence and outlines recommendations to improve our understanding and management of several potential procedure-related complications.The evidence in support of the following facts is presented: (1) Multifidus Atrophy After Lumbar Medial Branch Radiofrequency Neurotomy (LMBRFN) -- There is no conclusive published literature indicating that LMBRFN leads to increased multifidus atrophy relative to natural history. High-quality prospective studies with a natural history comparison group evaluating immediate pre-procedure as well as post-procedure longitudinal cross-sectional imaging are needed to accurately assess for any possible influence of LMBRFN on multifidus atrophy as well as the clinical relevance. (2) Intradiscal Biologics -- Although the available evidence on intradiscal biologic interventions is limited, it nonetheless shows a non-zero risk of complications. Until larger sample sizes are reported, the actual magnitude of the risk cannot be ascertained. In the meantime, physicians who perform intradiscal injections of biologics should conscientiously consider the risk-benefit of these procedures. (3) Lumbar Facet Synovial Cyst Rupture -- There have been few reports of complications secondary to lumbar facet synovial cyst rupture. Risks of may include increased pain, infection, and nerve root compression.

Painful Knee Osteoarthritis and Radiofrequency Neurotomy of Genicular Nerves

Painful Knee Osteoarthritis and Radiofrequency Neurotomy of Genicular Nerves

CRITICAL EVALUATIONS OF INTRA-ARTICULAR PLATELET RICH PLASMA ALONE OR COMBINATION WITH MEDIAL BRANCH RADIOFREQUENCY NEUROTOMY IN PATIENTS WITH LUMBAR FACET JOINT ARTHROPATHY: A PROSPECTIVE OUTCOME STUDY

Background: Common cause of chronic low back pain is lumbar facet joint arthropathy. Radiofrequency ablation (RFA) of medial branch currently preferred treatment in facet joint pain syndrome. Platelet-rich plasma (PRP) is known to initiate mesenchymal tissue healing by concentration of several fundamental protein growth factors. Our aim in this study is to evaluate the effect of co-administration of autologous PRP in lumbar facet and RFA of the medial branch of the dorsal ramus for lumbar facet arthropathy. Methodology: This was a prospective randomised study with a blind assessor. Eighty-one consecutive patients who complained of low back pain secondary to lumbar facet joint arthropathy were randomly allocated into three-groups: Group RF: only RFA done. Group PR: received both PRP plus RFA. Group PL: received only PRP. Primary outcome of the study was assessment of pain intensity using visual analogue scale (VAS). Result: The patients who had both RFA and PRP therapy had significant decrease in VAS score as compared to its baseline in the immediate and long term follow up period ([Formula: see text] &lt; 0.001). However, for those who received only PRP, the decrease in VAS was more significant at 1 and 4 months. Similarly, there was a significant improvement in ODI score in patients who received both RFA and PRP ([Formula: see text] &lt; 0.001). There was a gradual improvement in ODI in PRP group at 4-month interval. Rescue analgesics requirement was reduced and patients were better satisfied in those who received both RFA and PRP therapy. ([Formula: see text] &lt; 0.05). Conclusion: The combined administration of RFA and PRP proved to provide better analgesia in both short-term follow up and long-term follow up than treatment with either method in patients with lumbar facet syndrome.

Delphi-Based Expert Consensus Statements for the Management of Percutaneous Radiofrequency Neurotomy in the Treatment of Lumbar Facet Joint Syndrome.

A modified Delphi strategy was implemented for obtaining recommendations that could be useful in the management of percutaneous radiofrequency treatment of lumbar facet joint syndrome, as the literature on the argument was poor in quality. An Italian research team conducted a comprehensive literature search, defined the investigation topics (diagnosis, treatment, and outcome evaluation), and developed an explorative semi-structured questionnaire. They also selected the members of the panel. After an online meeting with the participants, the board developed a structured questionnaire of 15 closed statements (round 1). A five-point Likert scale was used and the cut-off for consensus was established at a minimum of 70% of the number of respondents (level of agreement ≥ 4, agree or strongly agree). The statements without consensus were rephrased (round 2). Forty-one clinicians were included in the panel and responded in both rounds. After the first round, consensus (≥ 70%) was obtained in 9 out of 15 statements. In the second round, only one out of six statements reached the threshold. The lack of consensus was observed for statements concerning the use of imaging for a diagnosis [54%, median 4, interquartile range (IQR) 3-5], number of diagnostic blocks (37%, median 4, IQR 2-4), bilateral denervation (59%, median 4, IQR 2-4), technique and number of lesions (66%, median 4, IQR 3-5), and strategy after denervation failure (68%, median 4, IQR 3-4). Results of the Delphi investigations suggest that there is a need to define standardized protocols to address this clinical problem. This step is essential for designing high-quality studies and filling current gaps in scientific evidence.

Ultrasound-guided lateral branch radiofrequency neurotomy for sacroiliac joint pain after lumbosacral spinal fusion surgery

Our study evaluated the clinical feasibility of ultrasound-guided lateral branch radiofrequency neurotomy for sacroiliac joint (SIJ) pain after lumbosacral spinal fusion surgery (LSFS). This prospective study included a total of 46 patients who were diagnosed with SIJ pain after LSFS, did not respond to conservative treatment and therefore underwent ultrasound-guided SIJ radiofrequency neurotomy (RFN) from January 2019 to January 2022. These patients were followed up for twelve months after the procedure. Patients were assessed with the Numeric Rating Scale (NRS) and the Oswestry Disability Index (ODI) preprocedural and postprocedural for 1 month, 6 months and 12 months follow-ups. There was a significant improvement in postprocedural NRS and ODI scores (p < 0.001). Thirty-eight patients (82.6%) had a satisfactory response and good global perceived effect (GPE) after twelve months. No significant complications were observed during the 12-month follow-up. The ultrasound-guided radiofrequency device designed as a safe, easily applied and encouraging method could avoid revision surgery. It is a promising technique and has shown good results in providing intermediate pain relief. In addition to the limited series reported in the literature, future studies will add meaning to this topic by including it in routine practice.