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Factors Predicting Success and Failure for Cervical Facet Radiofrequency Denervation: A Multi-Center Analysis
  1. Steven P. Cohen, M.D.,
  2. Zahid H. Bajwa, M.D.,
  3. Jan J. Kraemer, M.D.,
  4. Anthony Dragovich, M.D.,
  5. Kayode A. Williams, M.D.,
  6. Joshua Stream, B.S.,
  7. Anthony Sireci, B.S.,
  8. Giselle McKnight, C.R.N.A. and
  9. Robert W. Hurley, M.D., Ph.D.
  1. Pain Management Division, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD
  2. Department of Surgery, Walter Reed Army Medical Center, Washington, DC
  3. Pain Management Division, Department of Anesthesiology and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
  4. Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA
  5. Johns Hopkins School of Medicine, Baltimore, MD.
  1. Reprint requests: Steven P. Cohen, M.D., 550 North Broadway, Suite 301, Baltimore, MD 21029. E-mail: scohen40{at}jhmi.edu

Abstract

Background and Objectives: The concept of radiofrequency denervation has recently come under question in light of several studies showing minimal to no benefit. One possibility proposed for these negative outcomes is poor selection criteria. Unlike virtually all other spine interventions, the factors associated with success and failure for cervical facet denervation have yet to be determined. The purpose of this study is to determine which demographic, clinical and treatment factors are associated with cervical facet radiofrequency denervation outcomes.

Methods: Data were garnered from 3 academic medical centers on 92 patients with chronic neck pain who underwent radiofrequency denervation after a positive response to diagnostic local anesthetic blocks. Success was defined as at least 50% pain relief lasting at least 6 months. Variables evaluated for their association with outcome included age, sex, duration of pain, opioid use, pain referral pattern, paraspinal tenderness, pain exacerbated by extension/rotation, magnetic resonance image abnormalities, diabetes, smoking, scoliosis, obesity, prior surgery, and levels treated.

Results: The only clinical variable associated with success was paraspinal tenderness. Factors associated with treatment failure included radiation to the head, opioid use, and pain exacerbated by neck extension and/or rotation.

Conclusions: Selecting patients based on key clinical variables may increase the chance of treatment success for cervical facet radiofrequency denervation.

  • Cervical facet joint
  • Medial branch block
  • Neck pain
  • Predictive value
  • Radiofrequency
  • Zygapophyseal joint

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Footnotes

  • Funded in part by the John P. Murtha Neuroscience and Pain Institute, Johnstown, PA, and the Army Regional Anesthesia and Pain Medicine Initiative, Washington, DC. Presented at the 2007 American Society of Regional Anesthesia and Pain Medicine Annual Fall Meeting, October 13-17, 2007. San Francisco, CA.

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