Clinical predictors of success and failure for lumbar facet radiofrequency denervation.
OBJECTIVE
To determine the clinical factors associated with the success and failure of radiofrequency denervation of the lumbar facet joints.


METHODS
Clinical data were garnered from 3 academic medical centers on 192 patients with low back pain who underwent radiofrequency denervation after a positive response to diagnostic blocks. Success was defined as >/=50% pain relief lasting at least 6 months. Factors evaluated for their association with outcome included duration of pain, opioid use, symptom location, paraspinal tenderness, pain exacerbated by extension/rotation (ie, facet loading), MRI abnormalities, diabetes, smoking, scoliosis, obesity, prior surgery and levels treated.


RESULTS
The only factor associated with a successful outcome was paraspinal tenderness. Variables that correlated with treatment failure were 'facet loading,' long duration of pain, and previous back surgery.


CONCLUSIONS
It is counterproductive to use 'facet loading' as the sole basis for choosing patients for facet interventions. In patients at high risk for treatment failure, taking additional steps to reduce the rate of false-positive screening blocks may improve outcomes.
Cohen
Steven P
SP
Pain Management Division, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21029, USA. scohen40@jhmi.edu
Hurley
Robert W
RW
Christo
Paul J
PJ
Winkley
James
J
Mohiuddin
Meraj M
MM
Stojanovic
Milan P
MP
D000328:Adult; D000368:Aged; D003714:Denervation / Q000379:methods*; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000503:physiopathology / Q000532:radiotherapy* / Q000601:surgery; D008159:Lumbar Vertebrae / Q000294:innervation*; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D011379:Prognosis; D000078702:Radiofrequency Therapy; D013997:Time Factors; D016896:Treatment Outcome; D016474:Weight-Bearing