A Role of Percutaneous Radiofrequency Neurotomy of Posterior Primary Rami

초록

The purpose of this study is to prospectively evaluate the role of facetal deneravation (radiofrequency neurotomy of medial branch of posterior primary ramus) in selected patients with low back pain based on two temporary diagnostic blocks (saline and lidocaine) in double-blinded fashion. A total of 63 patients who met all inclusion criteria and responded to temporary block were included. Main inclusion criteria were axial and predominantly psedudoradicular pain exacerbated by extension and facetal irritation but not associated with clinical signs of motor, sensory deficits, sciatic compression, and radiographic findings suggestive of prominent disc or lesions of roots and cord. These patients had more than 6 months of pain and failed to obtain substantial benefits from at least 4–6 weeks of intense physiotherapy. Eighteen patients who had previously undergone lumbar disc surgeries but had persistent low back pain were also included. RF procedure was done under local anesthetics and performed according to side(s) of pain with modified technique. Minimal follow-up period was 24 months. Initial responders (>50% of pain relief) were 74.6% (47/63). At 6 month, this was reduced to 60.3% but 52.3% were still responders at 2-year follow up. Variables found to be not significant but have tendency to be related to outcome were positive sign of “4”, bilaterality, older age. Variables such as sex, age, and previous surgery showed no significant relationship to outcome. There were no major neurologic complications. These results indicate that this procedure may play a role in management of patients with specific clinical syndrome, presumably chronic low back pain of mechanical origin from facet joints or surrounding structures. It is considered safe and repeatable. Similar results obtained in patients with previous disc surgery may also have a role in management of selected patients with failed back surgery syndrome.

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