Pulsed radiofrequency application in treatment of chronic zygapophyseal joint pain☆
Introduction
Zygapophyseal joints (facet joints) are true synovial joints. They are innervated by medial branches of the dorsal rami from the spinal nerves. The facet joints have been suggested to be an important cause of pain by a number of authors [1], [2], [3], [4], [5], [6]. Theoretically, facet joint pain can be treated by denervation of the medial branches of the dorsal rami, which supply the sensory innervation of the joints [3], [4].
The application of radiofrequency (RF) current to the medical branches supplying facet joints has been established as a valid treatment option in the treatment of discomfort related to spondylosis [7], [8], [9]. RF current application to the spinal dorsal root ganglion has also been used treat painful radiculopathy [10]. Thermal RF, by generating heat in neural tissue up to 90 C and producing coagulation, carries potential risks of neuritis and spinal instability from denervation of the multifidus muscle. Also, experimental animal studies confirm the real risk of resulting neuritis after thermal coagulation of the dorsal root ganglion [11].
The application of pulsed RF is a new method in RF treatment. Pulsed RF is achieved by applying RF energy with a pulsed time cycle of 2×2 msec/second at temperatures not exceeding 42 C. Although the mechanism of its action is not completely understood, one of the prevailing theories postulates that the electrical fields reversibly disrupt the transmission of impulses across small unmyelinated fibers without destroying them, while larger fibers remain protected by the myelin sheath and are thus unaffected [12], [13], [14]. Maintaining the temperature at the tip of the electrode at 42 C ensures that neural structures are not damaged. The procedure itself is relatively painless, well tolerated and lacks potential adverse effects secondary to the high temperatures.
The goal of this retrospective study is to evaluate the efficacy of the application of pulsed RF waves to medial branches of dorsal rami in treatment of facet joint pain.
Section snippets
Patients and methods
The procedures were performed in the Pain Management Clinic, at the Medical College of Georgia, as outpatient procedures, from July 2000 to November 2001. Patients with a chief complaint of axial lumbar or cervical pain and who denied radicular symptoms underwent a single diagnostic medial branch block procedure using 0.5 ml of lidocaine 2% [9]. Those patients experiencing a positive response to a diagnostic medial branch were included. (Response was regarded as positive if pain score
Results
A visual analog scale was used to determine the effectiveness of the procedure. An outcome was regarded as successful if pain was decreased by more than 50% for more than 1.5 months.
Of 114 patients who had a positive response to diagnostic block, 46 patients did not respond favorably to pulsed RF application (pain reduction less than 50%).
In 68 patients, the procedure was successful and lasted on average 3.93±1.86 months. Eighteen patients had the procedure repeated subsequently.
The average
Discussion
The present results indicate that pulsed RF application to the articular nerves of both lumbar and cervical facet joints provides nearly 4 months of pain relief in patients with suspected facet joint pathology. It is appreciated that there are limitations in this retrospective analysis. Patient selection for facet-mediated pain, when based on clinical criteria, can always be problematic. The failure to perform more than one diagnostic medial branch block can also result in less than accurate
Conclusion
The results of this retrospective analysis showed that the application of pulsed RF to medial branches of the dorsal rami is a safe and useful intervention for temporary pain relief (approximately 4 months) from facet joints.
Acknowledgements
We thank Lois Kujawa, RN, for her essential part in facilitating the timely care of these patients.
References (16)
Low back pain with special reference to the articular facets with presentation as operative procedure
JAMA
(1933)- et al.
Percutaneous radiofrequency rhizotomy
Surg Neurol
(1974) Percutaneous radiofrequency denervation of spinal facets. Treatment for chronic back pain and sciatica
J Neurosurg
(1975)- et al.
The anatomy of the so-called “articular nerves” and their relationship to facet denervation in the treatment of low-back pain
J Neurosurg
(1979) - et al.
Substance P and innervation of lumbar spine facet joints
Spine
(1993) - et al.
Facet joint injection for low back pain. A clinical study
J Bone Joint Surg
(1986) The use of radiofrequency power in making lesions in the brain
Neurosurgery
(1960)- et al.
Principles and practice of radiofrequency neurolysis
Curr Rev Pain
(1998)
Cited by (119)
History of radiofrequency ablation (RFA)
2023, Radiofrequency Ablation Techniques: A Volume in the Atlas of Interventional Techniques SeriesThe Clinical Efficacy of High-Voltage Long-Duration Pulsed Radiofrequency Treatment in Pudendal Neuralgia: A Retrospective Study
2022, NeuromodulationCitation Excerpt :In this way, there is no irreversible damage to neural tissues, which can cause pain relief by modulating the pain perception without destroying the neural tissue.23 Therefore, as a nondestructive, well-tolerated, and minimally invasive interventional therapy, PRF has been widely used in the treatment of various kinds of chronic neuropathic pain that is refractory to conservative therapies.24,25 Conventional PRF is a conventional therapeutic strategy for PN5,22,26,27 and has been shown to be both safe and beneficial.5
A real-world evidence of a consecutive treatment of 42 spine-related pain using dorsal root ganglion-pulsed radiofrequency (DRG-PRF)
2020, Clinical Neurology and Neurosurgery
- ☆
FDA device/drug status: not applicable.
Nothing of value received from a commercial entity related to this research.