Advertisement

Neuroradiology

, Volume 54, Issue 7, pp 737–744 | Cite as

Medial branch neurotomy in low back pain

  • Salvatore Masala
  • Giovanni Nano
  • Matteo Mammucari
  • Stefano Marcia
  • Giovanni Simonetti
Interventional Neuroradiology

Abstract

Introduction

This study aimed to assess the effectiveness of pulsed radiofrequency medial branch dorsal ramus neurotomy in patients with facet joint syndrome.

Methods

From January 2008 to April 2010, 92 patients with facet joint syndrome diagnosed by strict inclusion criteria and controlled diagnostic blocks undergone medial branch neurotomy. We did not exclude patients with failed back surgery syndrome (FBSS). Electrodes (20G) with 5-mm active tip were placed under fluoroscopy guide parallel to medial branch. Patients were followed up by physical examination and by Visual Analog Scale and Oswestry Disability Index at 1, 6, and 12 months.

Results

In all cases, pain improvement was statistically significant and so quality of life. Three non-FBSS patients had to undergo a second neurotomy because of non-satisfactory pain decrease. Complications were reported in no case.

Conclusions

Medial branch radiofrequency neurotomy has confirmed its well-established effectiveness in pain and quality of life improvement as long as strict inclusion criteria be fulfilled and nerve ablation be accomplished by parallel electrode positioning. This statement can be extended also to FBSS patients.

Keywords

Radiofrequency neurotomy Low back pain Medial branch Failed back surgery syndrome Facet joint syndrome 

Notes

Conflict of interest

We declare that we have no conflict of interest.

References

  1. 1.
    Boswell MV, Shah RV, Everett CR et al (2005) Interventional techniques in the management of chronic spinal pain: evidence-based practice guidelines. Pain Physician 8:1–47PubMedGoogle Scholar
  2. 2.
    Sehgal N, Shah RV, McKenzie-Brown A et al (2005) Diagnostic utility of facet (zygapophysial) joint iniections in chronic spinal pain: a systematic review of evidence. Pain Physician 8:211–224PubMedGoogle Scholar
  3. 3.
    Datta S, Lee M, Falco FJ et al (2009) Systematic assessment of diagnostic accuracy and therapeutic utility of lumbar facet joint interventions. Pain Physician 12(2):437–460, ReviewPubMedGoogle Scholar
  4. 4.
    Sehgal N, Dunbar EE, Shah RV et al (2007) Systematic review of diagnostic utility of facet (zygapophysial) joint injections in chronic spinal pain: an update. Pain Physician 10(1):213–228, ReviewPubMedGoogle Scholar
  5. 5.
    Uematsu S, Udvarhelyi GB, Benson DW et al (1974) Percutaneous radiofrequency rhizotomy. Surg Neurol 2(5):319–325PubMedGoogle Scholar
  6. 6.
    Shealy CN (1975) Percutaneous radiofrequency denervation of spinal facets. Treatment for chronic back pain and sciatica. J Neurosurg 43(4):448–451PubMedCrossRefGoogle Scholar
  7. 7.
    Eisenstein SM, Parry CR (1987) The lumbar facet arthrosis syndrome: clinical presentation and articular surface changes. J Bone Joint Surg 69:3–7Google Scholar
  8. 8.
    Misaggi B, Gallazzi M, Colombo M et al (2009) Articular facets syndrome: diagnostic grading and treatment options. Eur Spine J 18(Suppl 1):49–51PubMedCrossRefGoogle Scholar
  9. 9.
    Dreyfuss P, Halbrook B, Pauza K et al (2000) Efficacy and validity of radiofrequency neurotomy for chronic lumbar zygapophysial joint pain. Spine (Phila Pa 1976) 25(10):1270–1277CrossRefGoogle Scholar
  10. 10.
    Fukui S, Ohseto K, Shiotani M et al (1997) Distribution of referred pain from the lumbar zygapophyseal joints and dorsal rami. Clin J Pain 13(4):303–307PubMedCrossRefGoogle Scholar
  11. 11.
    Pincus T, Hassett AL, Callahan LF (2009) Criterion contamination of depression scales in patients with rheumatoid arthritis: the need for interpretation of patient questionnaires (as all clinical measures) in the context of all information about the patient. Rheum Dis Clin North Am 35(4):861–864, xi–xiiPubMedCrossRefGoogle Scholar
  12. 12.
    Richter P, Werner J, Heerlein A et al (1998) On the validity of the Beck Depression Inventory. A review. Psychopathol 31(3):160–168CrossRefGoogle Scholar
  13. 13.
    Beck AT, Beck RW (1972) Screening depressed patients in family practice. A rapid technique. Postgrad Med 52(6):81–85PubMedGoogle Scholar
  14. 14.
    Deyo RA, Battie M, Beurskens AJ et al (1998) Outcome measures for low back pain research. A proposal for standardized use. Spine (Phila Pa 1976) 23(18):2003–2013CrossRefGoogle Scholar
  15. 15.
    Ostelo RW, Deyo RA, Stratford P et al (2008) Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change. Spine (Phila Pa 1976) 33(1):90–94CrossRefGoogle Scholar
  16. 16.
    Lee LJ, Coppieters MW, Hodges PW (2005) Differential activation of the thoracic multifidus and longissimus thoracis during trunk rotation. Spine (Phila Pa 1976) 30(8):870–876CrossRefGoogle Scholar
  17. 17.
    Kim BJ, Date ES, Derby R et al (2005) Electromyographic technique for lumbar multifidus examination: comparison of previous techniques used to localize the multifidus. Arch Phys Med Rehabil 86(7):1325–1329PubMedCrossRefGoogle Scholar
  18. 18.
    Haig AJ (1997) Clinical experience with paraspinal mapping. II: A simplified technique that eliminates three-fourths of needle insertions. Arch Phys Med Rehabil 78(11):1185–1190PubMedCrossRefGoogle Scholar
  19. 19.
    Bogduk N (1983) The innervation of the lumbar spine. Spine (Phila Pa 1976) 8(3):286–293CrossRefGoogle Scholar
  20. 20.
    Valencia FP, Munro RR (1985) An electromyographic study of the lumbar multifidus in man. Electromyogr Clin Neurophysiol 25(4):205–221PubMedGoogle Scholar
  21. 21.
    Dreyfuss P, Schwarzer AC, Lau P et al (1997) Specificity of lumbar medial branch and L5 dorsal ramus blocks: a computed tomography study. Spine 22:895–902PubMedCrossRefGoogle Scholar
  22. 22.
    Bogduk N (1997) International Spinal Injection Society guidelines for the performance of spinal injection procedures. Part 1: Zygapophysial joint blocks. Clin J Pain 13(4):285–302PubMedCrossRefGoogle Scholar
  23. 23.
    Rubin AP, Lawson DI (1968) A controlled trial of bupivacaine. A comparison with lignocaine. Anaesthesia 23(3):327–330PubMedCrossRefGoogle Scholar
  24. 24.
    Watt MJ, Ross DM, Atkinson RS (1968) A double-blind trial of bupivacaine and lignocaine. Latency and duration in extradural blockade. Anaesthesia 23(3):331–337PubMedCrossRefGoogle Scholar
  25. 25.
    Cousins MJ, Mather LE (1980) Clinical pharmacology of local anaesthetics. Anaesth Intensive Care 8(3):257–277PubMedGoogle Scholar
  26. 26.
    Bogduk N, Wilson AS, Tynan W (1982) The human lumbar dorsal rami. J Anat 134(Pt 2):383–397PubMedGoogle Scholar
  27. 27.
    Gofeld M, Faclier G (2008) Radiofrequency denervation of the lumbar zygapophysial joints—targeting the best practice. Pain Med 9(2):204–211PubMedCrossRefGoogle Scholar
  28. 28.
    Nath S, Nath CA, Pettersson K (2008) Percutaneous lumbar zygapophysial (Facet) joint neurotomy using radiofrequency current, in the management of chronic low back pain: a randomized double-blind trial. Spine (Phila Pa 1976) 33(12):1291–1297, discussion 1298CrossRefGoogle Scholar
  29. 29.
    Pino CA, Hoeft MA, Hofsess C et al (2005) Morphologic analysis of bipolar radiofrequency lesions: implications for treatment of the sacroiliac joint. Reg Anesth Pain Med 30(4):335–338PubMedGoogle Scholar
  30. 30.
    Schwarzer AC, Wang SC, O’Driscoll D et al (1995) The ability of computed tomography to identify a painful zygapophysial joint in patients with chronic low back pain. Spine (Phila Pa 1976) 20(8):907–912CrossRefGoogle Scholar
  31. 31.
    Weishaupt D, Zanetti M, Boos N et al (1999) MR imaging and CT in osteoarthritis of the lumbar facet joints. Skeletal Radiol 28(4):215–219PubMedCrossRefGoogle Scholar
  32. 32.
    Schofferman J, Kine G (2004) Effectiveness of repeated radiofrequency neurotomy for lumbar facet pain. Spine (Phila Pa 1976) 29(21):2471–2473, ReviewCrossRefGoogle Scholar
  33. 33.
    Lau P, Mercer S, Govind J, Bogduk N (2004) The surgical anatomy of lumbar medial branch neurotomy (facet denervation). Pain Med 5(3):289–298PubMedCrossRefGoogle Scholar
  34. 34.
    Stojanovic MP, Zhou Y, Hord ED, Vallejo R, Cohen SP (2003) Single needle approach for multiple medial branch blocks: a new technique. Clin J Pain 19(2):134–137PubMedCrossRefGoogle Scholar
  35. 35.
    Waguespack A, Schofferman J, Slosar P et al (2002) Etiology of long-term failures of lumbar spine surgery. Pain Med 3(1):18–22PubMedCrossRefGoogle Scholar
  36. 36.
    Slipman CW, Shin CH, Patel RK et al (2002) Etiologies of failed back surgery syndrome. Pain Med 3(3):200–214, discussion 214–7PubMedCrossRefGoogle Scholar
  37. 37.
    Schofferman J, Reynolds J, Herzog R et al (2003) Failed back surgery: etiology and diagnostic evaluation. Spine J 3(5):400–403PubMedCrossRefGoogle Scholar
  38. 38.
    Cohen SP, Williams KA, Kurihara C et al (2010) Multicenter, randomized, comparative cost-effectiveness study comparing 0, 1, and 2 diagnostic medial branch (facet joint nerve) block treatment paradigms before lumbar facet radiofrequency denervation. Anesthesiology 113(2):395–405PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Salvatore Masala
    • 1
  • Giovanni Nano
    • 1
    • 3
  • Matteo Mammucari
    • 1
  • Stefano Marcia
    • 2
  • Giovanni Simonetti
    • 1
  1. 1.Department of Diagnostic and Molecular ImagingInterventional Radiology and Radiotherapy University “Tor Vergata”RomeItaly
  2. 2.Department of Diagnostic and Molecular ImagingS. Giovanni di Dio HospitalCagliariItaly
  3. 3.Department of RadiologyUniversity “Tor Vergata”RomeItaly

Personalised recommendations