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  • pd0332991 Introduction Lumbar zygapophysial or facet joint

    2018-11-14

    Introduction Lumbar zygapophysial or facet joint pain has been suggested to be an important cause of chronic low back pain. Lumbar medial branch blocks are used to test if a patient\'s pain stems from a given lumbar facet joint. The diagnosis of facet joint pain is probable when there is at least 50%–75% relief of the targeted pain after lumbar medial branch blocks of the posterior rami of the spinal pd0332991 that supply the painful joints on two separate occasions. Percutaneous conventional radiofrequency (CRF) denervation of the medial branches of the dorsal rami has been used for facet joint pain management for many years. However, CRF is a neurodestructive procedure in which a constant high frequency and high-temperature electrical current is applied to target tissue. Thus, the procedure is not risk-free and irreversible nerve injury has been reported. Pulsed radiofrequency (PRF) lesioning is a new method in radiofrequency treatment of pain. It is a non-neurolytic lesioning method for pain relief and can relieve pain without evidence of neural damage. Although its mechanism of action is not completely understood, some preliminary reports support its long-term efficacy and safety in pain relief. The efficacy of PRF for lumbar facet joint pain is not well established because comparative studies with other modes of management are sparse. We performed a retrospective analysis of 16 patients with chronic lumbar facet joint pain treated by CRF and 18 patients managed by PRF who declined CRF, Clinical outcomes and complications were then compared between the CRF and PRF groups.
    Methods
    Results
    Discussion Lumbar zygapophysial or facet joint pain has been suggested to be an important cause of chronic low back pain. Although the articular branches to the lumbar facet joints could not be accurately targeted for percutaneous procedures, their parent nerves, medial branches of the dorsal rami, could constitute a valid target. Lumbar medial branch blocks are a diagnostic procedure to test if the pain stems from one or more given facet joints. Clinical treatment has been directed towards lesioning the medial branches of the dorsal rami with CRF to disrupt pain transmission from the facet joint to the central nervous system. Shealy first introduced the use of CRF for the treatment of chronic facet joint pain. Since then, its efficacy and safety have been established in multiple clinical trials. PRF lesioning is a new method in radiofrequency treatment of pain. Although the mechanism of action is not completely understood, some reports support its long-term efficacy and safety in pain relief. The efficacy of PRF for the treatment of chronic facet joint pain has not been well established. There are not enough studies demonstrating the efficacy for the chronic facet joint pain. Some retrospective studies demonstrated that PRF successfully provided pain relief for chronic lumbar facet joint pain. These studies had some limitations such as patient selection and the lack of a control group. Although some prospective controlled trials have been reported comparing the efficacy of CRF and PRF in the treatment of lumbar facet joint pain, these studies represented conflicting results. Kroll and colleagues conducted a prospective trial comparing the efficacy of CRF with PRF. Their study showed that PRF was not effective. Tekin and colleagues\' study showed both PRF and CRF were effective; however, the effect of PRF was not as long lasting as CRF. CRF is a therapeutic procedure in which a Teflon-coated electrode (NeuroTherm®) with an exposed tip is inserted onto a target nerve. The electrode heats the surrounding tissue and coagulates them, including the target nerve. The lesion made by the electrode does not extend distal to the tip of electrode, but instead it spreads radially along the long axis of the electrode. The lesion made by the CRF is maximal around the electrode shaft and smallest ahead of the tip. This would mean that the electrodes placed perpendicular to the target nerve would fail to coagulate the nerve adequately. In the technique introduced by Shealy the electrode is not inserted parallel to the target nerve. A modification for electrode placement requires that the electrode lie parallel to the nerve. Using adequate modification for electrode placement, the CRF group in our study was in line with Dreyfuss and others\' study and showed a good outcome in pain reduction and physical functioning.