Pulsed radiofrequency application in treatment of chronic zygapophyseal joint pain.
BACKGROUND
Chronic zygapophyseal joint arthropathy is a cause of back and neck pain. One proposed method of treating facet joint pathology is ablation of medial branches and dorsal rami with pulsed radiofrequency (RF) waves.


OBJECTIVE
Assessment of efficacy of pulsed RF application for treatment of chronic zygapophyseal joint pain.


METHODS
Retrospective study of 114 patients at a pain management clinic.


METHODS
A total of 114 patients with clinical signs of facet joint involvement and a favorable response to a diagnostic medial branch block using local anesthetic, including 82 females and 32 males with a mean age of 52.8+/-12.6 years. Mean duration of pain was 7.52+/-5.26 years. Twenty-seven had previous back surgery, 83 patients had low back pain and 31 had cervical pain. Pain was on the left side in 47 patients, on the right side in 45 patients, bilateral in 22.


METHODS
Result was regarded as successful if pain reduction was more than 50% on visual analog scale and the duration of effect was more than 1.5 months.


METHODS
After obtaining positive stimulation, pulsed RF was applied to medial branches of dorsal rami for 120 seconds with temperature at the tip of the electrode 42 C.


RESULTS
Of 114 patients, who had 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 with the same duration of pain relief that was achieved initially. Previous surgery, duration of pain, sex, levels (cervical vs. lumbar) and stimulation levels did not influence outcomes.


CONCLUSIONS
The results of our study showed that the application of pulsed RF to medial branches of the dorsal rami in patients with chronic facet joint arthropathy provided temporary pain relief in 68 of 118 patients.
Pain Medicine Program, Department of Anesthesiology, Medical College of Georgia, 1120 15th Street BIW 2144, Augusta, GA 30912, USA.
Georgi
G
Mikeladze
Ramon
R
Espinal
Robert
R
Finnegan
James
J
Routon
Dan
D
Martin
D001416:Back Pain / Q000503:physiopathology / Q000628:therapy*; D002574:Cervical Vertebrae; D002908:Chronic Disease; D003714:Denervation / Q000379:methods*; D004599:Electric Stimulation Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000503:physiopathology / Q000628:therapy*; D009407:Nerve Block / Q000379:methods; D010147:Pain Measurement; D012189:Retrospective Studies; D016896:Treatment Outcome; D021801:Zygapophyseal Joint / Q000294:innervation* / Q000503:physiopathology