Percutaneous radiofrequency facet capsule denervation as an alternative target in lumbar facet syndrome.
OBJECTIVE
Percutaneous radiofrequency denervation of the medial dorsal branch is often used in chronic low back pain of intervertebral facet etiology, which is sometimes difficult to perform and recurrence of pain often ensues. We theorized that shifting the target of RF coagulation to the facet joint capsule would provide an easier target and a longer-lived pain relieving response.


METHODS
A prospective randomized controlled trial where 120 patients diagnosed with CLBP of a confirmed facet origin were randomly divided into three equal groups, the first was submitted to percutaneous radiofrequency coagulation of the facet joint capsule, the second underwent percuataneous denervation of the medial dorsal branch and the third did not receive radiofrequency lesioning. All the three groups received local injection of a mixture of local anesthetic and steroid. Cases were followed for up to 3 years.


RESULTS
87(72.5%) patients were females. By 3 months' post procedure, improvement in VAS was significantly better than pretreatment levels in all groups (p<0.05). The control group lost improvement by 1-year follow-up (p=0.017). At 2 years' follow-up, the joint capsule denervation group maintained significant improvement (p=0.033) whereas the medial branch denervation group lost its significant effect (p=0.479). By the end of follow-up period, only joint capsule denervation group kept significant improvement (p=0.026).


CONCLUSIONS
In CLBP of facet origin, shifting the target of percutaneous radiofrequency to the facet joint capsule provides an easier technique with an extended period of pain relief compared to the medial dorsal branch of the facet joint.
Department of Neurosurgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt. Electronic address: waelmmosa@yahoo.com.
Wael Mohamed Mohamed
WM
Moussa
Department of Neurosurgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Wael
W
Khedr
D000293:Adolescent; D000328:Adult; D000359:Aftercare; D000368:Aged; D003714:Denervation / Q000379:methods*; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D061208:Pulsed Radiofrequency Treatment / Q000379:methods*; D055815:Young Adult; D021801:Zygapophyseal Joint / Q000000981:diagnostic imaging / Q000294:innervation*
Capsule; Chronic low back pain; Facet; Medial dorsal branch; Radiofrequency