LUMBAR 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 2013; 12(5): 639-45 (Link to PubMed)
Key Words: Chronic back pain – Lumbar Medial Branch – Thermal RF
Graphs created by Boston Scientific based on the published data
To determine the effectiveness of lumbar medial branch radiofrequency neurotomy (RFN) in conventional practice.
RFN practitioners: Lumbar RFN was performed by two experienced practitioners (two independent practices) trained according to rigorous guidelines.
Patients: 106 patients were selected to receive RFN based on complete lumbar pain relief following diagnostic medial branch blocks.
- 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 (including the return to work), 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 16-gauge (1.6 mm diameter) Cosman RRE electrodes.
- Either 10 cm or 15 cm electrodes were used, depending on the size of the patient. Electrodes with either 5 mm or 10 mm exposed tips were placed parallel to the medial branches, across the necks of the superior articular processes.
- RFN lesions were created to cover the likely location of the nerves.
- In the two practices, 58% (Practice A) and 53% (Practice B) of patients achieved a successful outcome, with complete pain relief and restoration of daily activities.
- In both practices, pain relief lasted 15 months, from the first RFN procedure.
- Allowing for repeat treatment, patients had sustained pain relief for a median duration of 13 months, with 70% of the patients still reporting relief at follow-up.
- Lumbar RFN can be very effective when performed in a rigorous manner in appropriately selected patients.
- Chronic back pain, mediated by the lumbar medial branches, can be stopped and patients fully restored to normal living, if treated with RFN.