CLINICAL EFFECTIVENESS OF INTRA-ARTICULAR PULSED RADIOFREQUENCY COMPARED TO INTRAARTICULAR CORTICOSTEROID INJECTION FOR MANAGEMENT OF ATLANTO-OCCIPITAL JOINT PAIN
Authors: Shin S.M, Kwak S.G, Lee D.G and Chang M.C
Study type: Prospective, randomized, controlled, pilot study
Publication: Acta Neurochirurgica 2019; 161(7):1427-34 (Link to PubMed)
Key Words: Chronic Neck - Upper Cervical Pain – Atlanto-occipital joint – Pulsed RF
Graphs created by Boston Scientific based on the published data
To assess the effectiveness of pulsed radiofrequency (PRF) stimulation on the atlanto-occipital (AO) joint in patients with chronic joint pain. The authors also compared the effect of AO intra-articular (IA) PRF and AO-IA corticosteroid injection (ICI)
Patients: 23 patients with spontaneous onset chronic upper cervical pain (suboccipital neck area) were prospectively recruited
- All patients failed to respond to conservative treatments (physical therapy and medication).
- Patients presented with a limited range of lateral flexion upon rotation of the AO joint and sustained pain for at least 6 months.
Study groups: Patients were randomized to receive either PRF (N=12) or ICI (N=11).Treatment was carried out by one experienced clinician.
- A Numeric Rating Scale (NRS) score was used to evaluate pain severity before treatment and 1,3, and 6 months after the procedure. Successful pain relief was defined as ≥50% reduction in baseline NRS score at 6 months.
AO-PRF procedure: A 22-gauge, 10-cm cannula with a 10-mm active tip (Cosman™ RF-CC10522) was inserted in the uppermost portion of the AO joint. PRF was performed with a Cosman™-G4 RF generator at 5Hz and 5ms pulse width for 360s at 55 V. Electrode tip temperature was maintained at or below 42°C.
AO-PRF procedure: A 25-gauge spinal needle was inserted into the AO joint. A mixture of anesthetic and corticosteroid was slowly injected.
- Chronic joint pain severity (mean NRS scores) was significantly reduced at 1, 3, and 6 months after each procedure (P<0.001).
- Successful pain relief was achieved in 66.7 % (8/12) of patients in the PRF group and 63.6 % (7/11) of the patients in the ICI group.
- The extent of pain reduction between the two procedures was not significantly different at 6 months post-treatment (P=0.879).
Intra-AO joint PRF stimulation could be a useful clinical treatment for patients with AO joint pain; especially for those prone to adverse effects derived from the use of corticosteroids.