title: Efficacy of combined treatment with medial branch radiofrequency neurotomy and steroid block in lumbar facet joint arthropathy.
abstract: OBJECTIVE
  To evaluate the long-term efficacy of combined radiofrequency (RF) neurotomy and steroid nerve block in patients with lumbar facet joint arthropathy.
  
  
  METHODS
  Combined RF neurotomy and steroid nerve block was performed in 34 patients with chronic paravertebral low back pain. The diagnosis was confirmed by comparative double diagnostic block of the medial branch with bupivacaine and lidocaine. Under fluoroscopy, RF thermal ablation of the medial branch was performed (at RF needle tip temperature 85°C for 90 seconds), three times for each target nerve. At the end of the procedure, 20 mg of methylprednisolone acetate (sustained-release preparation) was infiltrated on each ablated nerve. Outcome variable was the degree of improvement in pain using visual analog scale (VAS) and numerical rating scale (NRS). Improvement in the quality of life was assessed using the Roland-Morris (RM) questionnaire. The procedure was repeated in cases of unbearable pain (>5 VAS score).
  
  
  RESULTS
  Patients had a mean VAS score of 8.6 before the procedure. Thereafter, VAS score was 0.91 immediately after the procedure and 3.0, 2.8, 3.7, and 3.6 at 1 month, 2 months, 6 months, and 1 year. NRS showed pain relief after the procedure of 85%, 65%, 78%, 62%, and 59.5% at the same time points. RM score was 18 before the procedure, 7.6 at 6 months after the procedure, and 8.5 at 1 year after the procedure. No major complication was noted except local pain in all patients and numbness of the back in six patients after the procedure.
  
  
  CONCLUSIONS
  Combined RF neurotomy and steroid nerve block produced substantial improvement in terms of long-term pain relief and quality of life.
authors.affiliation: Departments of Pain Management, Institute of Neurosciences Kolkata, 185/1 AJC Bose Road, Kolkata 700017, West Bengal 700017, India. replychinmoy@yahoo.ca
authors.forename: Chinmoy
authors.initials: C
authors.lastname: Roy
authors.forename: Nilay
authors.initials: N
authors.lastname: Chatterjee
authors.forename: Sudeshna
authors.initials: S
authors.lastname: Ganguly
authors.forename: Robin
authors.initials: R
authors.lastname: Sengupta
mesh_terms: D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000627:therapeutic use; D001177:Arthropathy, Neurogenic / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D017115:Catheter Ablation / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods; D010865:Pilot Projects; D013256:Steroids / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult; D021801:Zygapophyseal Joint / Q000187:drug effects / Q000601:surgery*
chemical_list: D000779:Anesthetics, Local; D013256:Steroids