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  • Randomized prospective trial of cooled versus traditional radiofrequency ablation of the medial branch nerves for the treatment of lumbar facet joint pain

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Randomized prospective trial of cooled versus traditional radiofrequency ablation of the medial branch nerves for the treatment of lumbar facet joint pain
  1. Zachary L McCormick1,
  2. Heejung Choi2,
  3. Rajiv Reddy3,
  4. Raafay H Syed4,
  5. Meghan Bhave5,
  6. Mark C Kendall6,
  7. Dost Khan7,
  8. Geeta Nagpal7,
  9. Masaru Teramoto7 and
  10. David R Walega7
  1. 1 Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah, USA
  2. 2 Department of Anesthesiology, University of Arkansas Medical Sciences, Little Rock, Arkansas, USA
  3. 3 Department of Anesthesiology, University of California San Diego, San Diego, California, USA
  4. 4 Department of Orthopedics, Stanford University, Palo Alto, California, USA
  5. 5 Northwest Suburban Pain Center, Schaumberg, Illinois, USA
  6. 6 Department of Anesthesiology, Brown University, Providence, Rhode Island, USA
  7. 7 Department of Anesthesiology, Northwestern University, Chicago, Illinois, USA
  1. Correspondence to Zachary L McCormick, Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT 84103, USA; Zachary.McCormick{at}hsc.utah.edu

Abstract

Background and objectives No previous study has assessed the outcomes of cooled radiofrequency ablation (C-RFA) of the medial branch nerves (MBN) for the treatment of lumbar facet joint pain nor compared its effectiveness with traditional RFA (T-RFA). This study evaluated 6-month outcomes for pain, function, psychometrics, and medication usage in patients who underwent MBN C-RFA versus T-RFA for lumbar Z-joint pain.

Methods In this blinded, prospective trial, patients with positive diagnostic MBN blocks (>75% relief) were randomized to MBN C-RFA or T-RFA. The primary outcome was the proportion of ‘responders’ (≥50% Numeric Rating Scale (NRS) reduction) at 6 months. Secondary outcomes included NRS, Oswestry Disability Index (ODI), and Patient Global Impression of Change.

Results Forty-three participants were randomized to MBN C-RFA (n=21) or T-RFA (n=22). There were no significant differences in demographic variables (p>0.05). A ≥50% NRS reduction was observed in 52% (95% CI 31% to 74%) and 44% (95% CI 22% to 69%) of participants in the C-RFA and T-RFA groups, respectively (p=0.75). A ≥15-point or ≥30% reduction in ODI score was observed in 62% (95% CI 38% to 82%) and 44% (95% CI 22% to 69%) of participants in the C-RFA and T-RFA groups, respectively (p=0.21).

Conclusions When using a single diagnostic block paradigm with a threshold of >75% pain reduction, both treatment with both C-RFA and T-RFA resulted in a success rate of approximately 50% when defined by both improvement in pain and physical function at 6-month follow-up. While the success rate was higher in the C-RFA group, this difference was not statistically significant.

Trial registration number NCT02478437.

https://doi.org/10.1136/rapm-2018-000035

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    Footnotes

    • Funding This study was supported by the 2014 Addison Blonsky Research Grant from the Midwest Pain Society.

    • Competing interests ZLMcC serves on the board of directors for the Spine Intervention Society. The authors otherwise declare no potential conflicts of interest.

    • Patient consent Obtained.

    • Ethics approval Northwestern University Institutional Review Board (STU00097239).