What is the efficacy of radiofrequency (RF) medial branch neurotomy for the treatment of low back pain (LBP)?

Updated: Aug 22, 2018
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

Answer

In a 2000 review, Manchikanti et al cite strong evidence that RF denervation provides short-term relief (< 6 mo) and moderate evidence for long-term relief (>6 mo) of chronic cervical, thoracic, and lumbar spinal pain of facet origin. [152] A randomized trial by Lord compared 12 patients receiving medial branch RF lesions of the cervical dorsal rami to the same number of patients receiving a sham procedure. [153] Seven patients in the treatment group and one in the control group remained free of pain. Overall, patients receiving medial branch neurotomies had a long-term success rate of 75%.

In another randomized trial, 47% of the treatment group showed sustained improvement following RF denervation at 12 months. Improvement measures included the reduction of pain, functional disability, and physical impairment. These and other studies show strong support for both a short- and long-term benefit from RF medial branch neurotomy for the treatment of lumbar facet syndrome in patients with cLPB. [137] Potential side effects of RF denervation include painful cutaneous dysesthesia or hyperesthesia and pneumothorax and deafferentation pain. [154]

Boswell et al have suggested that a form of medial branch neurotomy resulting in >50% relief for 10-12 weeks can be applied at intervals of 3 months or longer (up to a maximum of 3 times/y) between each procedure, provided that all regions are treated at the same time and the procedure can be performed safely. [136]


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