Comparison of alcohol ablation with repeated thermal radiofrequency ablation in medial branch neurotomy for the treatment of recurrent thoracolumbar facet joint pain
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Chemical denervation is not recommended as part of the routine care of chronic non-cancer pain. Physicians face a dilemma when it comes to repeated interventions in cases of recurrent thoracolumbar facet joint pain after successful thermal radiofrequency ablation (RFA) in medial branch neurotomy. This study was performed to compare the effects of alcohol ablation (AA) with thermal RFA in patients with recurrent thoracolumbar facet joint pain after thermal RFA treatment.
Forty patients with recurrent thoracolumbar facet joint pain after successful thermal RFA defined as a numeric rating scale (NRS) score of ≥7 or a revised Oswestry disability index (ODI) of ≥22 % were randomly allocated to two groups receiving either the same repeated RFA (n = 20) or AA (n = 20). The recurrence rate was assessed with NRS and ODI during the next 24 months, and adverse events in each group were recorded.
During the 24-month follow-up after RFA and AA, one and 17 patients, respectively, were without recurring thoracolumbar facet joint pain. The median effective periods in the RFA and AA groups were 10.7 (range 5.4–24) and 24 (range 16.8–24) months, respectively (p < 0.000). No significant complications were observed with the exception of injection site pain, which occurred in both groups.
In our patient cohort, alcohol ablation in medial branch neurotomy provided a longer period of pain relief and better quality of life than repeated radiofrequency medial branch neurotomy in the treatment of recurrent thoracolumbar facet joint pain syndrome after successful thermal RFA without significant complications during the 24-month follow-up.
- Soloman M, Mekhail MN, Mekhail N. Radiofrequency treatment in chronic pain. Expert Rev Neurother. 2010;10:469–74. CrossRef
- Schofferman J, Kine G. Effectiveness of repeated radiofrequency neurotomy for lumbar facet pain. Spine. 2004;29:2471–3. CrossRef
- Govind J, Bogduk N. Neurolytic blockade for noncancer pain. In: Fishman SM, Ballantyne JC, Rathmell JP, editors. 4th ed. Bonica’s management of pain. Philadelphia: Wolters Kluwer Lippincott William & Wilkins; 2010. p. 1467–85.
- American Society of Anesthesiologists Task Force on Chronic Pain Management; American Society of Regional Anesthesia and Pain Medicine. Practice guidelines for chronic pain management: an updated report by the American Society of Anesthesiologists Task Force on Chronic Pain Management and the American Society of Regional Anesthesia and Pain Medicine. Anesthesiology. 2010;112:810–33.
- Hudson-Cook N, Tomes-Nicholson K, Breen A. A revised Oswestry disability questionnaire. In: Roland M, Jenner JR, editors. Back pain: new approaches to rehabilitation and education. Manchester: Manchester University Press; 1989. p. 187–204.
- Manchikanti L, Singh V, Falco FJ, Cash KA, Pampati V. Effectiveness of thoracic medial branch blocks in managing chronic pain: a preliminary report of a randomized, double-blind controlled trial. Pain Phys. 2008;11:491–504.
- Manchikanti L, Datta S, Gupta S, Munglani R, Bryce DA, Ward SP, Benyamin RM, Sharma ML, Helm S 2nd, Fellows B, Hirsch JA. A critical review of the American Pain Society Clinical practice guidelines for interventional techniques: part 2 Therapeutic interventions. Pain Phys. 2010;13:E215–64.
- Koyyalagunta D, Burton AW. The role of chemical neurolysis in cancer pain. Curr Pain Headache Rep. 2010;14:261–7. CrossRef
- Vatansever D, Tekin I, Tuglu I, Erbuyun K, Ok G. A comparison of the neuroablative effects of conventional and pulsed radiofrequency techniques. Clin J Pain. 2008;24:717–24. CrossRef
- Silvers HR. Lumbar percutaneous facet rhizotomy. Spine. 1990;15:36–40. CrossRef
- Shealy CN. Percutaneous radiofrequency denervation of spinal facets. Treatment for chronic back pain and sciatica. J Neurosurg. 1975;43:448–51. CrossRef
- Son JH, Kim SD, Kim SH, Lim DJ, Park JY. The efficacy of repeated radiofrequency medial branch neurotomy for lumbar facet syndrome. J Korean Neurosurg Soc. 2010;48:240–3. CrossRef
- Navarro X. Chapter 27: neural plasticity after nerve injury and regeneration. Int Rev Neurobiol. 2009;87:483–505. CrossRef
- Comparison of alcohol ablation with repeated thermal radiofrequency ablation in medial branch neurotomy for the treatment of recurrent thoracolumbar facet joint pain
Journal of Anesthesia
Volume 27, Issue 3 , pp 390-395
- Cover Date
- Print ISSN
- Online ISSN
- Springer Japan
- Additional Links
- Ablation technique
- Ethyl alcohol
- Facet joint
- Radiofrequency catheter ablation
- Industry Sectors
- Author Affiliations
- 1. Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Korea
- 2. Pain Clinic, Pusan National University Yangsan Hospital, Bumeuri, Mulgeumup, Yangsan, Kyungsangnamdo, 626-770, Korea