CERVICAL MEDIAL BRANCH RADIOFREQUENCY NEUROTOMY IN NEW ZEALAND
Authors: MacVicar J, Borowczyk J, MacVicar A, Loughnan B, and Bogduk N.
Study type: Prospective, multicenter, real-world study
Publication: Pain Medicine 2012; 13(5): 647-54 (Link to PubMed)
Key Words: Neck pain – cervical medial branch - zygapophysial joint – Thermal RF
Graphs created by Boston Scientific based on the published data
To determine the effectiveness of cervical medial branch radiofrequencyneurotomy (RFN) in conventional practice.
RFN practitioners: Cervical RFN was performed by two experienced practitioners (two independent practices) trained according to rigorous guidelines.
Patients: 104 patients were selected to receive RFN based on complete cervical pain relief following diagnostic medial branch blocks. Patients presented with neck pain of potential cervical zygapophysial joint origin.
- Patient’s VAS and NRS pain scores, as well as daily living activities were recorded before treatment and during follow-up visits post-procedure.
- Data recording and analysis were performed in a double-blind setup.
- Complete pain relief, for at least 6 months, accompanied by complete restoration of daily living activities and no need for any other health care intervention, was adopted as the cardinal criterion for a successful outcome.
RFN procedure: All procedures were carried out with 10 cm - 16-gauge (1.6 mm diameter) Cosman™ RRE electrodes with 5 mm exposed tips.
- The electrodes were placed parallel to the medial branches, and sufficiently large lesions were created in both the sagittal and oblique planes (30° to sagittal), to cover the likely location of the nerves (C5). On average, two lesions in each plane were created.
- The temperatures used were 80° (sagittal) and 85° (oblique) and maintained for 90 seconds for each lesion.
- In the two practices, 74% (Practice A) and 61% (Practice B) of patients achieved a successful outcome, with complete pain relief and restoration of daily activities
- In both practices, pain relief lasted 17-20 months from the first RFN procedure
- Allowing for repeat treatment, patients had sustained pain relief for a median duration of 20-26 months, with 60% of the patients still having relief at follow-up.
- Cervical RFN can be very effective when performed in a rigorous manner in appropriately selected patients.
- Chronic neck pain, mediated by the cervical medial branches, can be temporarily, but completely, relieved and patients fully restored to normal activities of daily living, if treated with RFN.