Randomized trial of radiofrequency lumbar facet denervation for chronic low back pain.
METHODS
A prospective double-blind randomized trial in 31 patients.


OBJECTIVE
To assess the clinical efficacy of percutaneous radiofrequency denervation of the lumbar zygapophysial joints in reducing pain, functional disability, and physical impairment in patients with back pain originating from the lumbar zygapophysial joints.


BACKGROUND
Chronic low back pain is a major health problem in the industrialized world. A treatment option is percutaneous radiofrequency denervation of the lumbar zygapophysial joints. Its clinical efficacy has never been formally tested in a controlled trial.


METHODS
Thirty-one patients with a history of at least 1 year of chronic low back pain were selected on the basis of a positive response to a diagnostic nerve blockade and subsequently randomly assigned to one of two treatment groups. Each patient in the radiofrequency treatment group (15 patients) received an 80 C radiofrequency lesion of the dorsal ramus of the segmental nerve roots L3, L4, and L5. Patients in the control group (n = 16) underwent an the same procedure but without use of a radiofrequency current. Both the treating physician and the patients were blinded to the group assignment. Before treatment, physical impairment, rating of pain, the degree of disability, and quality of life were assessed by a blinded investigator.


RESULTS
Eight weeks after treatment, there were 10 success patients in the radiofrequency group (n = 15) and 6 in the sham group (n = 16). The unadjusted odds ratio was 3.3 (P = 0.05, not significant), and the adjusted odds ratio was 4.8 (P < 0.05, significant). The differences in effect on the visual analog scale scores, global perceived effect, and the Oswestry disability scale were statistically significant. Three, 6, and 12 months after treatment, there were significantly more success patients in the radiofrequency group compared with the sham group.


CONCLUSIONS
Radiofrequency lumbar zygapophysial joint denervation results in a significant alleviation of pain and functional disability in a select group of patients with chronic low back pain, both on a short-term and a long-term basis.
van Kleef
M
M
Department of Anaesthesiology, Pain Management and Research Centre, Maastricht, The Netherlands. mvk@sane.azm.nl
Barendse
G A
GA
Kessels
A
A
Voets
H M
HM
Weber
W E
WE
de Lange
S
S
D000328:Adult; D002908:Chronic Disease; D003714:Denervation / Q000379:methods*; D004185:Disability Evaluation; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000294:innervation*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010147:Pain Measurement; D011446:Prospective Studies; D011788:Quality of Life; D011859:Radiography; D013126:Spinal Nerve Roots / Q000000981:diagnostic imaging / Q000601:surgery*; D004561:Transcutaneous Electric Nerve Stimulation; D016896:Treatment Outcome