title: Success of initial and repeated medial branch neurotomy for zygapophysial joint pain: a systematic review.
abstract: OBJECTIVE
  To review the duration of pain relief after initial and repeated radiofrequency neurotomy (RFN) for cervical and lumbar zygapophysial joint pain.
  
  
  METHODS
  We searched PubMed to identify all articles that met review criteria for in-depth analysis, synthesis, and review.
  
  
  RESULTS
  Data from 16 articles are reported in this review, including 8 cervical studies, 7 lumbar studies, and 1 study of both cervical and lumbar treatment. Overall, methodology and design quality of cervical studies exceeded that of lumbar studies. For initial cervical RFN, average range duration of >50% pain relief was 7.3-8.6 months. Repeated cervical RFN was successful 67%-95% of the time when the first RFN procedure was successful. When the first RFN procedure was unsuccessful, repeated RFN was successful 0%-67% of the time. The average range duration of pain relief after successful repeated RFN was 6.0-12.7 months. For initial lumbar RFN, the average duration of >50% pain relief was 9.0 months. Repeated lumbar RFN was successful 33%-85% of the time when the first RFN procedure was successful. The average duration of pain relief after successful repeated lumbar RFN was 11.6 months.
  
  
  CONCLUSIONS
  The results of this review indicate that pain relief after initial RFN generally ends after 7-9 months and that repeating RFN is likely to provide additional pain relief if initial RFN was successful. Results are similar between cervical and lumbar spine studies.
authors.affiliation: PM&R Section, Department of Orthopaedic Surgery, Stanford University Spine Center, Redwood City, CA 94063, USA. msmuck@stanford.edu
authors.forename: Matthew
authors.initials: M
authors.lastname: Smuck
authors.forename: Ralph A
authors.initials: RA
authors.lastname: Crisostomo
authors.forename: Kavita
authors.initials: K
authors.lastname: Trivedi
authors.forename: Divya
authors.initials: D
authors.lastname: Agrawal
mesh_terms: D001416:Back Pain / Q000209:etiology / Q000601:surgery*; D003714:Denervation / Q000379:methods*; D006801:Humans; D010147:Pain Measurement; D011846:Radio Waves; D013127:Spinal Nerves / Q000601:surgery*; D021801:Zygapophyseal Joint / Q000294:innervation*