Medial branch blocks versus pericapsular blocks in selecting patients for percutaneous cryodenervation of lumbar facet joints.
OBJECTIVE
At many institutions, it is not practically feasible to perform a series of controlled or placebo-controlled medial branch blocks on several facet joints in order to select patients for facet joint rhizotomy. As for uncontrolled blocks, there is no proof that medial branch blocks are superior to other types of blocks. This study was performed to compare medial branch blocks to simple pericapsular blocks for the selection of patients for lumbar facet joint cryodenervation.


METHODS
Patient selection was based on history, imaging, and physical examination. Diagnostic blocks were either medial branch blocks or pericapsular blocks. Percutaneous medial branch cryodenervation was performed by use of a Lloyd Neurostat 2000. Outcome parameters were low back pain (visual analog scale [VAS]), limitation of activity (Macnab), and overall satisfaction. A total of 26 patients were recruited, 13 for each group. Follow-up was 6 months.


RESULTS
Patients who had been selected by medial branch blocks had better pain relief than did patients who had been diagnosed by use of pericapsular blocks. At 6 weeks and at 3 months after treatment, these results reached statistical significance (VAS 2.2 v 4.2, P < .05).


CONCLUSIONS
Our results suggest that uncontrolled medial branch blocks are superior to pericapsular blocks in selecting patients for facet joint cryodenervation, but both blocks work. If serial controlled blocks cannot be used, lumbar facet joint pain remains a diagnostic dilemma.
Birkenmaier
Christof
C
Department of Orthopedic Surgery, Grosshadern Medical Center, Ludwig-Maximilian-University, Munich, Germany. christof@doctor-b.de
Veihelmann
Andreas
A
Trouillier
Hans-Heinrich
HH
Hausdorf
Jörg
J
von Schulze Pellengahr
Christoph
C
D000465:Algorithms; D003452:Cryosurgery; D003714:Denervation; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D010147:Pain Measurement; D017060:Patient Satisfaction; D011446:Prospective Studies; D016896:Treatment Outcome; D021801:Zygapophyseal Joint / Q000294:innervation / Q000601:surgery*