Multicenter, randomized, comparative cost-effectiveness study comparing 0, 1, and 2 diagnostic medial branch (facet joint nerve) block treatment paradigms before lumbar facet radiofrequency denervation.
BACKGROUND
Among patients presenting with axial low back pain, facet arthropathy accounts for approximately 10-15% of cases. Facet interventions are the second most frequently performed procedures in pain clinics across the United States. Currently, there are no uniformly accepted criteria regarding how best to select patients for radiofrequency denervation.


METHODS
A randomized, multicenter study was performed in 151 subjects with suspected lumbar facetogenic pain comparing three treatment paradigms. Group 0 received radiofrequency denervation based solely on clinical findings; group 1 underwent denervation contingent on a positive response to a single diagnostic block; and group 2 proceeded to denervation only if they obtained a positive response to comparative blocks done with lidocaine and bupivacaine. A positive outcome was predesignated as > or =50% pain relief coupled with a positive global perceived effect persisting for 3 months.


RESULTS
In group 0, 17 patients (33%) obtained a successful outcome at 3 months versus eight patients (16%) in group 1 and 11 (22%) patients in group 2. Denervation success rates in groups 0, 1, and 2 were 33, 39, and 64%, respectively. Pain scores and functional capacity were significantly lower at 3 months but not at 1 month in group 2 subjects who proceeded to denervation compared with patients in groups 0 and 1. The costs per successful treatment in groups 0, 1, and 2 were $6,286, $17,142, and $15,241, respectively.


CONCLUSIONS
Using current reimbursement scales, these findings suggest that proceeding to radiofrequency denervation without a diagnostic block is the most cost-effective treatment paradigm.
Cohen
Steven P
SP
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA. scohen40@jhmi.edu
Williams
Kayode A
KA
Kurihara
Connie
C
Nguyen
Conner
C
Shields
Cynthia
C
Kim
Peter
P
Griffith
Scott R
SR
Larkin
Thomas M
TM
Crooks
Matthew
M
Williams
Necia
N
Morlando
Benny
B
Strassels
Scott A
SA
D000328:Adult; D000368:Aged; D017115:Catheter Ablation / Q000191:economics*; D003362:Cost-Benefit Analysis; D003714:Denervation / Q000191:economics; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis* / Q000191:economics* / Q000628:therapy; D008159:Lumbar Vertebrae / Q000294:innervation*; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000191:economics*; D016896:Treatment Outcome; D055815:Young Adult; D021801:Zygapophyseal Joint / Q000294:innervation*