Morphologic changes in the lumbar spine after lumbar medial branch radiofrequency neurotomy: a quantitative radiological study.
BACKGROUND
Medial branch radiofrequency neurotomy (RFN) is a common treatment for zygapophyseal joint pain. The lumbar medial branch innervates these joints and adjacent structures. The impact of the intended neurotomy on these structures remains unclear. No studies have yet verified quantitatively the effect of medial branch RFN on intervertebral discs, facet joints, and multifidus cross-sectional area.


OBJECTIVE
The aim of this study was to determine, using objective radiographic measures, whether there is a quantitative difference in the lumbar multifidus muscle cross-sectional area, facet joint degeneration, or intervertebral disc degeneration after segmental medial branch RFN.


METHODS
This is a retrospective single-cohort study performed at a university spine center.


METHODS
The patient sample consisted of 27 patients treated with lumbar medial branch RFN, with pre- and posttreatment magnetic resonance images available for analysis.


METHODS
The primary study outcome measure was interval change in fat-subtracted multifidus cross-sectional area, and intervertebral disc and zygapophyseal joint degeneration grade.


METHODS
In this retrospective study, segmental levels unaffected by RFN treatment were used as controls to compare against levels affected by treatment.


RESULTS
Levels affected by RFN demonstrated a significantly greater amount of disc degeneration compared with unaffected levels (14.9% vs. 4.6%; p=.0489). There was no statistical difference in the multifidus cross-sectional area or rates of deterioration in the zygapophyseal joints observed.


CONCLUSIONS
The full impact of RFN on multifidus function, morphology, and segmental anatomy is unknown. This retrospective study indicates that measurable changes in segmental morphology may occur after lumbar medial branch RFN. These findings require validation in a prospective, controlled study.
Department of Orthopaedic Surgery, Stanford University Spine Center, 450 Broadway St, Redwood City, CA 94063, USA. Electronic address: msmuck@stanford.edu.
Mathew
M
Smuck
Department of Physical Medicine and Rehabilitation, Spine Center, Kaiser Permanente, 975 Sereno Dr, Vallejo, CA 94589, USA.
Ralph A
RA
Crisostomo
Department of Orthopaedic Surgery, Stanford University Spine Center, 450 Broadway St, Redwood City, CA 94063, USA.
Ryan
R
Demirjian
Department of Physical Medicine and Rehabilitation, University of Michigan, 325 E Eisenhower Pkwy, Ann Arbor, MI 48108, USA.
David S
DS
Fitch
Department of Orthopaedic Surgery, Stanford University Spine Center, 450 Broadway St, Redwood City, CA 94063, USA.
David J
DJ
Kennedy
Department of Physical Medicine and Rehabilitation, University of Michigan, 325 E Eisenhower Pkwy, Ann Arbor, MI 48108, USA.
Michael E
ME
Geisser
D000328:Adult; D000368:Aged; D017115:Catheter Ablation / Q000379:methods*; D015331:Cohort Studies; D003714:Denervation / Q000379:methods*; D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000473:pathology; D055959:Intervertebral Disc Degeneration / Q000473:pathology*; D017116:Low Back Pain / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000473:pathology*; D008160:Lumbosacral Plexus / Q000601:surgery*; D008161:Lumbosacral Region; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D064170:Paraspinal Muscles / Q000473:pathology*; D012189:Retrospective Studies; D021801:Zygapophyseal Joint / Q000294:innervation* / Q000473:pathology
Back pain; Medial branch; Radiofrequency; Zygapophyseal joint