Literature Support Thermocoagulation Radiofrequency Neurotomy
Spine. 2004 Nov 1;29(21):2471-3.
Effectiveness of repeated radiofrequency neurotomy for lumbar facet pain.
Schofferman J, Kine G. SpineCare Medical Group, San Francisco Spine Institute, Daly City, California, USA.
jschofferman@spinecare.com
STUDY DESIGN: Retrospective chart review. OBJECTIVES: To determine the success rate and duration of relief of repeat
radiofrequency neurotomy for lumbar facet joint pain. SUMMARY OF BACKGROUND DATA: Radiofrequency neurotomy is an
effective but temporary management of lumbar facet pain. When pain recurs, radiofrequency neurotomy is usually repeated, but
the outcome and duration of relief for repeat radiofrequency neurotomies are unknown. METHODS: Record review of consecutive
patients who had an initial successful radiofrequency neurotomy, subsequent recurrence of pain, and then repeat
radiofrequency neurotomy. Responses of repeat radiofrequency neurotomies were compared with initial radiofrequency
neurotomy for success rates and duration of relief. RESULTS: There were 16 women and 4 men. Mean age was 48 years
(range, 26-63). Radiofrequency neurotomy denervated one segment in two patients, two segments in 16 patients, and three or
more in two patients. There were 10 bilateral and 10 unilateral radiofrequency neurotomies. Mean duration of relief after initial
radiofrequency neurotomy was 10.5 months (range, 4-19). To date, two patients had a series of two radiofrequency neurotomies
performed, six had three, five had four, three had five, and four had seven or more. Twenty patients had a second
radiofrequency neurotomy, which was successful in 17 (85%) but unsuccessful in two. The mean duration of relief in 16 of these
17 patients was 11.6 months (range, 6-19), and relief is continuing in one. Sixteen patients had a third radiofrequency
neurotomy, of which 15 were successful and one was unsuccessful. The mean duration of relief in nine of the 15 was 11.2
months (range, 5-23), and relief is continuing in the other six. Eight patients had a fourth radiofrequency neurotomy, which was
successful in seven but unsuccessful in one.The mean duration of relief was 9 months (range, 5-14) in three patients, and
relief is continuing in the other four. None of these differences is significant. The frequency of success and durations of relief
remained consistent after each subsequent radiofrequency neurotomy. CONCLUSIONS: Repeated radiofrequency neurotomies
are an effective long-term palliative management of lumbar facet pain. Each radiofrequency neurotomy had a mean duration of
relief of 10.5 months and was successful more than 85% of the time.
Spine. 2001 Jun 15;26(12):E268-73. Radiofrequency medial branch neurotomy in litigant and nonlitigant patients with cervical
whiplash: a prospective study. Sapir DA, METHODS: Sixty patients with cervical whiplash who remained symptomatic after 20
weeks of conservative management were referred for radiofrequency cervical medial neurotomy. The patients were classified
as litigant or nonlitigant based on whether the potential for monetary gain via litigation existed. Each group underwent identical
evaluation and treatment. Patients were observed for 1 year. Visual analogue scores and self-reported
improvement were obtained before, immediately after, and 1 year after radiofrequency cervical medial neurotomy. RESULTS:
Forty-six patients completed the study. The overall reduction in cervical whiplash symptoms and visual analogue pain scores
were significant immediately after treatment (nonlitigants vs. litigants: 2.0 vs. 2.5, P = 0.36) and at 1 year (nonlitigants vs.
litigants: 2.9 vs. 4.0, P = 0.05). One-year follow-up scores were higher than immediate post-treatment scores (nonlitigants vs.
litigants: 2.5 vs. 3.6). The difference between litigants and nonlitigants in the degree of symptomatology or response
to treatment did not reach significance. CONCLUSIONS: These results demonstrate that the potential for secondary gain in
patients who have cervical facet arthropathy as a result of a whiplash injury does not influence response to treatment. These
data contradict the common notion that litigation promotes malingering. This study also confirms the efficacy of radiofrequency
medial branch neurotomy in the treatment of traumatic cervical facet arthropathy.
Reg Anesth Pain Med. 2001 Sep-Oct;26(5):394-400.
Comment in: Reg Anesth Pain Med. 2001 Sep-Oct;26(5):389-93.
Efficacy of radiofrequency procedures for the treatment of spinal pain: a systematic review of randomized clinical trials.
Geurts JW, van Wijk RM, Stolker RJ, Groen GJ. Department of Anesthesiology, Rijnstate Hospital, Arnhem, The Netherlands.
anesthesiologen.arnhem@planet.nl
BACKGROUND AND OBJECTIVES: The use of radiofrequency (RF) procedures in the peripheral nervous system to treat chronic
spinal pain has been the subject of controversy. Publications concerned only uncontrolled studies, and irreversible
nervous tissue damage was believed to be responsible for the effect, if any. In recent years, randomized, controlled studies have
appeared, which have attested to an increasing use of these techniques. This is a systematic review of
randomized controlled trials on RF procedures for spinal pain. METHODS: We performed a standardized literature search for
randomized, controlled trials. Three adjudicators independently registered trial methodology and outcome using
validated and subject-related instruments. Interadjudicator disagreement was resolved by discussion. It was found necessary to
devise additional parameters of study assessment. RESULTS: Six trials met the inclusion criteria. This small
number, along with clinical and technical heterogeneity precluded statistical analysis. All studies, whether high or low quality,
reported positive outcomes. CONCLUSIONS: We conclude that there is moderate evidence that RF lumbar facet denervation is
more effective for chronic low back pain than placebo. Limited evidence exists for efficacy of RF neurotomy in chronic cervical
zygapophyseal joint pain after flexion-extension injury. There is limited evidence that RF heating of the dorsal root ganglion is
more effective than placebo in chronic cervicobrachialgia. We recommend the systematic application of our additional
parameter assessments for future evaluations of RF studies. These additional parameters should also be used in the
preparation of future trial protocols of RF procedures for the treatment of chronic pain.
Spine. 2000 May 15;25(10):1270-7. Efficacy and validity of radiofrequency neurotomy for chronic lumbar zygapophysial joint pain.
Dreyfuss P, Halbrook B, Pauza K, Joshi A, McLarty J, Bogduk N. Spine Specialists, East Texas Medical Center Neurological
Institute, Tyler, TX 75701, USA. PaulDSpine@aol.com
STUDY DESIGN: A prospective audit. OBJECTIVE: To establish the efficacy of lumbar medial branch neurotomy under optimum
conditions. SUMMARY OF BACKGROUND DATA: Previous reports of the efficacy of lumbar medial branch neurotomy have been
confounded by poor patient selection, inaccurate surgical technique, and inadequate assessment of outcome. METHODS:
Fifteen patients with chronic low back pain whose pain was relieved by controlled, diagnostic medial branch blocks of the
lumbar zygapophysial joints, underwent lumbar medial branch neurotomy. Before surgery, all were evaluated by
visual analog scale and a variety of validated measures of pain, disability, and treatment satisfaction. Electromyography of the
multifidus muscle was performed before and after surgery to ensure accuracy of the neurotomy. All outcome measures were
repeated at 6 weeks, and 3, 6, and 12 months after surgery.
RESULTS: Some 60% of the patients obtained at least 90% relief of pain at 12 months, and 87% obtained at least 60% relief.
Relief was associated with denervation of the multifidus in those segments in which the medial branches had been coagulated.
Prelesion electrical stimulation of the medial branch nerve with measurement of impedance was not associated with outcome.
CONCLUSIONS: Lumbar medial branch neurotomy is an effective means of reducing pain in patients carefully selected on the
basis of controlled diagnostic blocks. Adequate coagulation of the target nerves can be achieved by
carefully placing the electrode in correct position as judged radiologically. Electrical stimulation before lesioning is superfluous
in assuring correct placement of the electrode.
Can J Neurol Sci. 2000 May;27(2):125-30.
Percutaeous radiofrequency facet rhizotomy--experience with 118 procdedures and reappraisal of its value.
Tzaan WC, Tasker RR
Second Division of Neurosurgery, Chang Gung University and Chang Gung Memorial Hospital, Taoyuan, Taiwan.
BACKGROUND: There have been many reports of percutaneous radiofrequency facet rhizotomy, perhaps better referred to as
facet denervation, usually performed
under general anaesthesia, with inconsistent success rates. OBJECTIVES: To report the authors' outcome data using both
general and local anaesthesia and to reassess the value of this controversial procedure. METHODS: Our experience with
118 consecutive percutaneous radiofrequency facet rhizotomies performed on 90 patients in the Toronto Western Hospital was
analyzed. Sixty percent of the procedures were performed under general anaesthesia, 40% under local
anaesthesia. All patients had been temporarily virtually relieved of pain after local anaesthetic blockade of the subject facets by
an independent radiologist. RESULTS: The patients were monitored from 1-33 (mean 5.6) months after surgery,with complete
elimination or a greater than 50% subjective reduction of pain considered the criteria for success. For the first or only procedure
this was 41% overall, 37% in cases done under local anaesthesia, 46% in cases done under general anaesthesia (difference
not statistically significant p=0.52). There was no statistically significant difference in success rates for procedures
performed in the cervical, thoracic or lumbosacral facets, with unilateral versus bilateral denervations, when two to three as
compared with more than three facets were denervated, nor for operations done in patients who had had
previous spinal surgery compared with those who had not. Results were not better regardless of whether hyperextension of the
spine aggravated the patient's preoperative pain or not, and when the procedures were repeated in the same
patient outcomes tended to be consistent, arguing against repetition of failed facet denervations. The morbidity was low, the
chief problem being sensory loss and transient neuropathic pain in the distribution of cutaneous branches of
posterior rami in the cervical and thoracic areas; mortality was zero. CONCLUSIONS: Percutaneous radiofrequency facet
denervation is simple and safe, still worth considering in patients with disabling spinal pain that fails to
respond to conservative treatment. The use of general anaesthesia shortens the operating time and the patient's discomfort
without impairing success rate.
Neurosurgery. 1999 Jul;45(1):61-7; discussion 67-8. Long-term follow-up of patients treated with cervical radiofrequency
neurotomy for chronic neck pain. McDonald GJ, Lord SM, Bogduk N. Newcastle Bone and Joint Institute, University of Newcastle,
NSW, Australia. OBJECTIVE: To determine the long-term efficacy of percutaneous radiofrequency medial branch neurotomy in
the treatment of chronic neck pain. METHODS: Between 1991 and 1996, radiofrequency neurotomy was performed in 28
patients diagnosed as having cervical zygapophysial joint pain on the basis of controlled diagnostic blocks.
The procedure was repeated in patients whose pain recurred. Outcome measures were the proportion of patients who
responded to the initial procedure and the duration of relief subsequently obtained. Outcome was correlated with the operator
performing the procedure, the type of electrode used, litigation status, and the type of diagnostic blocks used to establish the
diagnosis. RESULTS: Complete relief of pain was obtained in 71% of patients after an initial procedure. No patient who failed to
respond to a first procedure responded to a repeat procedure, but if pain returned after a successful initial procedure,
relief could be reinstated by a repeat procedure. The median duration of relief after a first procedure was 219 days when failures
are included but 422 days when only successful cases are considered. The median duration of relief after repeat procedures
was at least 219 days; several patients had ongoing relief at the time of follow-up. Outcome did not differ according to the
operator, the type of electrode used, litigation status, or the type of diagnostic block used.
CONCLUSION: Radiofrequency neurotomy provides clinically significant and satisfying periods of freedom from pain
Spine. 1999 Sep 15;24(18):1937-42.
Randomized trial of radiofrequency lumbar facet denervation for chronic low back pain.van Kleef M, Barendse GA, Kessels A,
Voets HM, Weber WE, de Lange S.Department of Anaesthesiology, Pain Management and Research Centre, Maastricht,
The Netherlands. mvk@sane.azm.nl STUDY DESIGN: A prospective double-blind randomized trial in 31 patients.
OBJECTIVES: To assess the clinical efficacy of percutaneous radiofrequency denervation of the lumbar zygapophysial joints in
reducing pain, functional disability, and physical impairment in patients with back pain originating from
the lumbar zygapophysial joints. SUMMARY OF BACKGROUND DATA: Chronic low back pain is a major health problem in the
industrialized world. A treatment option is percutaneous radiofrequency denervation of the lumbar zygapophysial joints. Its
clinical efficacy has never been formally tested in a controlled trial. METHODS: Thirty-one patients with a history of at least 1 year
of chronic low back pain were selected on the basis of a positive response to a diagnostic nerve blockade and subsequently
randomly assigned to one of two treatment groups. Each patient in the radiofrequency treatment group (15 patients)
received an 80 C radiofrequency lesion of the dorsal ramus of the segmental nerve roots L3, L4, and L5. Patients in the control
group (n = 16) underwent an the same procedure but without use of a radiofrequency current. Both the
treating physician and the patients were blinded to the group assignment. Before treatment, physical impairment, rating of pain,
the degree of disability, and quality of life were assessed by a blinded investigator. RESULTS: Eight weeks
after treatment, there were 10 success patients in the radiofrequency group (n = 15) and 6 in the sham group (n = 16). The
unadjusted odds ratio was 3.3 (P =0.05, not significant), and the adjusted odds ratio was 4.8 (P < 0.05,
significant). The differences in effect on the visual analog scale scores, global perceived effect, and the Oswestry disability scale
were statistically significant. Three, 6, and 12 months after treatment, there were significantly
more success patients in the radiofrequency group compared with the sham group. CONCLUSIONS: Radiofrequency lumbar
zygapophysial joint denervation results in a significant alleviation of pain and functional disability in a select group of
patients with chronic low back pain, both on a short-term and a long-term basis.
Stereotact Funct Neurosurg. 1997;68(1-4 Pt 1):212-7.
Percutaneous radiofrequency lumbar facet rhizotomy in mechanical low back pain syndrome.
Cho J, Park YG, Chung SS. Department of Neurosurgery, Kon-Kuk University Medical Center Seoul Hospital,
College of Medicine, Korea. chojoon@kkucc.konkuk.ac.kr During the period from March 1992 to June 1996, we performed
percutaneous radiofrequency (RF) facet rhizotomy in 324 patients with low back pain. Employing the lesion generator, we
coagulated branches of the zygapophyseal nerve to treat low back pain. The follow-up period was 6-51 months (average:
22.5 months). There were no complications during the procedure and the follow-up period and no poor results were observed.
Two-hundred and thirty-one patients (103 females and 128 males) had mechanical low back pain syndrome and showed
marked improvement of pain after the procedure, including 29 cases with previous spinal surgery. We concluded that
percutaneous RF facet rhizotomy is a safe and effective procedure for low back pain patients, especially for those with
mechanical low back pain syndrome.
Stereotact Funct Neurosurg. 1997;68(1-4 Pt 1):212-7.
Percutaneous radiofrequency lumbar facet rhizotomy in mechanical low back pain syndrome. Cho J, Park YG, Chung SS.
Department of Neurosurgery, Kon-Kuk University Medical Center Seoul Hospital, College of Medicine, Korea.
chojoon@kkucc.konkuk.ac.kr During the period from March 1992 to June 1996, we performed percutaneous
radiofrequency (RF) facet rhizotomy in 324 patients with low back pain. Employing the lesion generator, we coagulated branches
of the zygapophyseal nerve to treat low back pain. The follow-up period was 6-51 months (average: 22.5 months). There were no
complications during the procedure and the follow-up period and no poor results were observed. Two-hundred and thirty-one
patients (103 females and 128 males) had mechanical low back pain syndrome and showed marked improvement of pain after
the procedure, including 29 cases with previous spinal surgery. We concluded that percutaneous RF facet rhizotomy is a safe
and effective procedure for low back pain patients, especially for those with mechanical low back pain syndrome.
Acta Neurochir (Wien). 1993;122(1-2):82-90.
Percutaneous facet denervation in chronic thoracic spinal pain.
Stolker RJ, Vervest AC, Groen GJ.
Pain Clinic University Hospital Utrecht, The Netherlands. In 40 patients with chronic thoracic spinal pain of more than 12 months
duration which failed to respond to conservative treatment and with a previous evaluation by specialists, mainly neurologists and
orthopaedic surgeons, the diagnosis of facet syndrome was made. This diagnosis was based on clinical criteria and a transient
positive response to a prognostic blockade of the medial branch of the dorsal ramus of the thoracic spinal nerve. They were
selected to undergo percutaneous radiofrequency denervation of the facet joints. The short and long-term results of 51
percutaneous thoracic facet denervations in 40 patients are described. After 2 months, 19 patients (47.5%) were pain-free, 14
patients (35%) had more than 50% pain-relief, and 7 patients (17.5%) had no relief. After a follow-up of 18-54 (average 31)
months in 36 cases (3 patients had died because of malignancy, and 1 had undergone a spinal fusion), 16 patients (44%)
were pain-free, 14 patients (39%) had more than 50% pain-relief and in 6 cases (17%) the result was poor. Adverse effects
consisted of postoperative pain in 5 patients (12.5%). When conservative treatment fails, percutaneous thoracic facet
denervation can be a safe and beneficial therapy in chronic thoracic spinal pain originating from the facet joints.
Spine. 2004 Nov 1;29(21):2471-3.
Effectiveness of repeated radiofrequency neurotomy for lumbar facet pain.
Schofferman J, Kine G. SpineCare Medical Group, San Francisco Spine Institute, Daly City, California, USA.
jschofferman@spinecare.com
STUDY DESIGN: Retrospective chart review. OBJECTIVES: To determine the success rate and duration of relief of repeat
radiofrequency neurotomy for lumbar facet joint pain. SUMMARY OF BACKGROUND DATA: Radiofrequency neurotomy is an
effective but temporary management of lumbar facet pain. When pain recurs, radiofrequency neurotomy is usually repeated, but
the outcome and duration of relief for repeat radiofrequency neurotomies are unknown. METHODS: Record review of consecutive
patients who had an initial successful radiofrequency neurotomy, subsequent recurrence of pain, and then repeat
radiofrequency neurotomy. Responses of repeat radiofrequency neurotomies were compared with initial radiofrequency
neurotomy for success rates and duration of relief. RESULTS: There were 16 women and 4 men. Mean age was 48 years
(range, 26-63). Radiofrequency neurotomy denervated one segment in two patients, two segments in 16 patients, and three or
more in two patients. There were 10 bilateral and 10 unilateral radiofrequency neurotomies. Mean duration of relief after initial
radiofrequency neurotomy was 10.5 months (range, 4-19). To date, two patients had a series of two radiofrequency neurotomies
performed, six had three, five had four, three had five, and four had seven or more. Twenty patients had a second
radiofrequency neurotomy, which was successful in 17 (85%) but unsuccessful in two. The mean duration of relief in 16 of these
17 patients was 11.6 months (range, 6-19), and relief is continuing in one. Sixteen patients had a third radiofrequency
neurotomy, of which 15 were successful and one was unsuccessful. The mean duration of relief in nine of the 15 was 11.2
months (range, 5-23), and relief is continuing in the other six. Eight patients had a fourth radiofrequency neurotomy, which was
successful in seven but unsuccessful in one.The mean duration of relief was 9 months (range, 5-14) in three patients, and
relief is continuing in the other four. None of these differences is significant. The frequency of success and durations of relief
remained consistent after each subsequent radiofrequency neurotomy. CONCLUSIONS: Repeated radiofrequency neurotomies
are an effective long-term palliative management of lumbar facet pain. Each radiofrequency neurotomy had a mean duration of
relief of 10.5 months and was successful more than 85% of the time.
Spine. 2001 Jun 15;26(12):E268-73. Radiofrequency medial branch neurotomy in litigant and nonlitigant patients with cervical
whiplash: a prospective study. Sapir DA, METHODS: Sixty patients with cervical whiplash who remained symptomatic after 20
weeks of conservative management were referred for radiofrequency cervical medial neurotomy. The patients were classified
as litigant or nonlitigant based on whether the potential for monetary gain via litigation existed. Each group underwent identical
evaluation and treatment. Patients were observed for 1 year. Visual analogue scores and self-reported
improvement were obtained before, immediately after, and 1 year after radiofrequency cervical medial neurotomy. RESULTS:
Forty-six patients completed the study. The overall reduction in cervical whiplash symptoms and visual analogue pain scores
were significant immediately after treatment (nonlitigants vs. litigants: 2.0 vs. 2.5, P = 0.36) and at 1 year (nonlitigants vs.
litigants: 2.9 vs. 4.0, P = 0.05). One-year follow-up scores were higher than immediate post-treatment scores (nonlitigants vs.
litigants: 2.5 vs. 3.6). The difference between litigants and nonlitigants in the degree of symptomatology or response
to treatment did not reach significance. CONCLUSIONS: These results demonstrate that the potential for secondary gain in
patients who have cervical facet arthropathy as a result of a whiplash injury does not influence response to treatment. These
data contradict the common notion that litigation promotes malingering. This study also confirms the efficacy of radiofrequency
medial branch neurotomy in the treatment of traumatic cervical facet arthropathy.
Reg Anesth Pain Med. 2001 Sep-Oct;26(5):394-400.
Comment in: Reg Anesth Pain Med. 2001 Sep-Oct;26(5):389-93.
Efficacy of radiofrequency procedures for the treatment of spinal pain: a systematic review of randomized clinical trials.
Geurts JW, van Wijk RM, Stolker RJ, Groen GJ. Department of Anesthesiology, Rijnstate Hospital, Arnhem, The Netherlands.
anesthesiologen.arnhem@planet.nl
BACKGROUND AND OBJECTIVES: The use of radiofrequency (RF) procedures in the peripheral nervous system to treat chronic
spinal pain has been the subject of controversy. Publications concerned only uncontrolled studies, and irreversible
nervous tissue damage was believed to be responsible for the effect, if any. In recent years, randomized, controlled studies have
appeared, which have attested to an increasing use of these techniques. This is a systematic review of
randomized controlled trials on RF procedures for spinal pain. METHODS: We performed a standardized literature search for
randomized, controlled trials. Three adjudicators independently registered trial methodology and outcome using
validated and subject-related instruments. Interadjudicator disagreement was resolved by discussion. It was found necessary to
devise additional parameters of study assessment. RESULTS: Six trials met the inclusion criteria. This small
number, along with clinical and technical heterogeneity precluded statistical analysis. All studies, whether high or low quality,
reported positive outcomes. CONCLUSIONS: We conclude that there is moderate evidence that RF lumbar facet denervation is
more effective for chronic low back pain than placebo. Limited evidence exists for efficacy of RF neurotomy in chronic cervical
zygapophyseal joint pain after flexion-extension injury. There is limited evidence that RF heating of the dorsal root ganglion is
more effective than placebo in chronic cervicobrachialgia. We recommend the systematic application of our additional
parameter assessments for future evaluations of RF studies. These additional parameters should also be used in the
preparation of future trial protocols of RF procedures for the treatment of chronic pain.
Spine. 2000 May 15;25(10):1270-7. Efficacy and validity of radiofrequency neurotomy for chronic lumbar zygapophysial joint pain.
Dreyfuss P, Halbrook B, Pauza K, Joshi A, McLarty J, Bogduk N. Spine Specialists, East Texas Medical Center Neurological
Institute, Tyler, TX 75701, USA. PaulDSpine@aol.com
STUDY DESIGN: A prospective audit. OBJECTIVE: To establish the efficacy of lumbar medial branch neurotomy under optimum
conditions. SUMMARY OF BACKGROUND DATA: Previous reports of the efficacy of lumbar medial branch neurotomy have been
confounded by poor patient selection, inaccurate surgical technique, and inadequate assessment of outcome. METHODS:
Fifteen patients with chronic low back pain whose pain was relieved by controlled, diagnostic medial branch blocks of the
lumbar zygapophysial joints, underwent lumbar medial branch neurotomy. Before surgery, all were evaluated by
visual analog scale and a variety of validated measures of pain, disability, and treatment satisfaction. Electromyography of the
multifidus muscle was performed before and after surgery to ensure accuracy of the neurotomy. All outcome measures were
repeated at 6 weeks, and 3, 6, and 12 months after surgery.
RESULTS: Some 60% of the patients obtained at least 90% relief of pain at 12 months, and 87% obtained at least 60% relief.
Relief was associated with denervation of the multifidus in those segments in which the medial branches had been coagulated.
Prelesion electrical stimulation of the medial branch nerve with measurement of impedance was not associated with outcome.
CONCLUSIONS: Lumbar medial branch neurotomy is an effective means of reducing pain in patients carefully selected on the
basis of controlled diagnostic blocks. Adequate coagulation of the target nerves can be achieved by
carefully placing the electrode in correct position as judged radiologically. Electrical stimulation before lesioning is superfluous
in assuring correct placement of the electrode.
Can J Neurol Sci. 2000 May;27(2):125-30.
Percutaeous radiofrequency facet rhizotomy--experience with 118 procdedures and reappraisal of its value.
Tzaan WC, Tasker RR
Second Division of Neurosurgery, Chang Gung University and Chang Gung Memorial Hospital, Taoyuan, Taiwan.
BACKGROUND: There have been many reports of percutaneous radiofrequency facet rhizotomy, perhaps better referred to as
facet denervation, usually performed
under general anaesthesia, with inconsistent success rates. OBJECTIVES: To report the authors' outcome data using both
general and local anaesthesia and to reassess the value of this controversial procedure. METHODS: Our experience with
118 consecutive percutaneous radiofrequency facet rhizotomies performed on 90 patients in the Toronto Western Hospital was
analyzed. Sixty percent of the procedures were performed under general anaesthesia, 40% under local
anaesthesia. All patients had been temporarily virtually relieved of pain after local anaesthetic blockade of the subject facets by
an independent radiologist. RESULTS: The patients were monitored from 1-33 (mean 5.6) months after surgery,with complete
elimination or a greater than 50% subjective reduction of pain considered the criteria for success. For the first or only procedure
this was 41% overall, 37% in cases done under local anaesthesia, 46% in cases done under general anaesthesia (difference
not statistically significant p=0.52). There was no statistically significant difference in success rates for procedures
performed in the cervical, thoracic or lumbosacral facets, with unilateral versus bilateral denervations, when two to three as
compared with more than three facets were denervated, nor for operations done in patients who had had
previous spinal surgery compared with those who had not. Results were not better regardless of whether hyperextension of the
spine aggravated the patient's preoperative pain or not, and when the procedures were repeated in the same
patient outcomes tended to be consistent, arguing against repetition of failed facet denervations. The morbidity was low, the
chief problem being sensory loss and transient neuropathic pain in the distribution of cutaneous branches of
posterior rami in the cervical and thoracic areas; mortality was zero. CONCLUSIONS: Percutaneous radiofrequency facet
denervation is simple and safe, still worth considering in patients with disabling spinal pain that fails to
respond to conservative treatment. The use of general anaesthesia shortens the operating time and the patient's discomfort
without impairing success rate.
Neurosurgery. 1999 Jul;45(1):61-7; discussion 67-8. Long-term follow-up of patients treated with cervical radiofrequency
neurotomy for chronic neck pain. McDonald GJ, Lord SM, Bogduk N. Newcastle Bone and Joint Institute, University of Newcastle,
NSW, Australia. OBJECTIVE: To determine the long-term efficacy of percutaneous radiofrequency medial branch neurotomy in
the treatment of chronic neck pain. METHODS: Between 1991 and 1996, radiofrequency neurotomy was performed in 28
patients diagnosed as having cervical zygapophysial joint pain on the basis of controlled diagnostic blocks.
The procedure was repeated in patients whose pain recurred. Outcome measures were the proportion of patients who
responded to the initial procedure and the duration of relief subsequently obtained. Outcome was correlated with the operator
performing the procedure, the type of electrode used, litigation status, and the type of diagnostic blocks used to establish the
diagnosis. RESULTS: Complete relief of pain was obtained in 71% of patients after an initial procedure. No patient who failed to
respond to a first procedure responded to a repeat procedure, but if pain returned after a successful initial procedure,
relief could be reinstated by a repeat procedure. The median duration of relief after a first procedure was 219 days when failures
are included but 422 days when only successful cases are considered. The median duration of relief after repeat procedures
was at least 219 days; several patients had ongoing relief at the time of follow-up. Outcome did not differ according to the
operator, the type of electrode used, litigation status, or the type of diagnostic block used.
CONCLUSION: Radiofrequency neurotomy provides clinically significant and satisfying periods of freedom from pain
Spine. 1999 Sep 15;24(18):1937-42.
Randomized trial of radiofrequency lumbar facet denervation for chronic low back pain.van Kleef M, Barendse GA, Kessels A,
Voets HM, Weber WE, de Lange S.Department of Anaesthesiology, Pain Management and Research Centre, Maastricht,
The Netherlands. mvk@sane.azm.nl STUDY DESIGN: A prospective double-blind randomized trial in 31 patients.
OBJECTIVES: To assess the clinical efficacy of percutaneous radiofrequency denervation of the lumbar zygapophysial joints in
reducing pain, functional disability, and physical impairment in patients with back pain originating from
the lumbar zygapophysial joints. SUMMARY OF BACKGROUND DATA: Chronic low back pain is a major health problem in the
industrialized world. A treatment option is percutaneous radiofrequency denervation of the lumbar zygapophysial joints. Its
clinical efficacy has never been formally tested in a controlled trial. METHODS: Thirty-one patients with a history of at least 1 year
of chronic low back pain were selected on the basis of a positive response to a diagnostic nerve blockade and subsequently
randomly assigned to one of two treatment groups. Each patient in the radiofrequency treatment group (15 patients)
received an 80 C radiofrequency lesion of the dorsal ramus of the segmental nerve roots L3, L4, and L5. Patients in the control
group (n = 16) underwent an the same procedure but without use of a radiofrequency current. Both the
treating physician and the patients were blinded to the group assignment. Before treatment, physical impairment, rating of pain,
the degree of disability, and quality of life were assessed by a blinded investigator. RESULTS: Eight weeks
after treatment, there were 10 success patients in the radiofrequency group (n = 15) and 6 in the sham group (n = 16). The
unadjusted odds ratio was 3.3 (P =0.05, not significant), and the adjusted odds ratio was 4.8 (P < 0.05,
significant). The differences in effect on the visual analog scale scores, global perceived effect, and the Oswestry disability scale
were statistically significant. Three, 6, and 12 months after treatment, there were significantly
more success patients in the radiofrequency group compared with the sham group. CONCLUSIONS: Radiofrequency lumbar
zygapophysial joint denervation results in a significant alleviation of pain and functional disability in a select group of
patients with chronic low back pain, both on a short-term and a long-term basis.
Stereotact Funct Neurosurg. 1997;68(1-4 Pt 1):212-7.
Percutaneous radiofrequency lumbar facet rhizotomy in mechanical low back pain syndrome.
Cho J, Park YG, Chung SS. Department of Neurosurgery, Kon-Kuk University Medical Center Seoul Hospital,
College of Medicine, Korea. chojoon@kkucc.konkuk.ac.kr During the period from March 1992 to June 1996, we performed
percutaneous radiofrequency (RF) facet rhizotomy in 324 patients with low back pain. Employing the lesion generator, we
coagulated branches of the zygapophyseal nerve to treat low back pain. The follow-up period was 6-51 months (average:
22.5 months). There were no complications during the procedure and the follow-up period and no poor results were observed.
Two-hundred and thirty-one patients (103 females and 128 males) had mechanical low back pain syndrome and showed
marked improvement of pain after the procedure, including 29 cases with previous spinal surgery. We concluded that
percutaneous RF facet rhizotomy is a safe and effective procedure for low back pain patients, especially for those with
mechanical low back pain syndrome.
Stereotact Funct Neurosurg. 1997;68(1-4 Pt 1):212-7.
Percutaneous radiofrequency lumbar facet rhizotomy in mechanical low back pain syndrome. Cho J, Park YG, Chung SS.
Department of Neurosurgery, Kon-Kuk University Medical Center Seoul Hospital, College of Medicine, Korea.
chojoon@kkucc.konkuk.ac.kr During the period from March 1992 to June 1996, we performed percutaneous
radiofrequency (RF) facet rhizotomy in 324 patients with low back pain. Employing the lesion generator, we coagulated branches
of the zygapophyseal nerve to treat low back pain. The follow-up period was 6-51 months (average: 22.5 months). There were no
complications during the procedure and the follow-up period and no poor results were observed. Two-hundred and thirty-one
patients (103 females and 128 males) had mechanical low back pain syndrome and showed marked improvement of pain after
the procedure, including 29 cases with previous spinal surgery. We concluded that percutaneous RF facet rhizotomy is a safe
and effective procedure for low back pain patients, especially for those with mechanical low back pain syndrome.
Acta Neurochir (Wien). 1993;122(1-2):82-90.
Percutaneous facet denervation in chronic thoracic spinal pain.
Stolker RJ, Vervest AC, Groen GJ.
Pain Clinic University Hospital Utrecht, The Netherlands. In 40 patients with chronic thoracic spinal pain of more than 12 months
duration which failed to respond to conservative treatment and with a previous evaluation by specialists, mainly neurologists and
orthopaedic surgeons, the diagnosis of facet syndrome was made. This diagnosis was based on clinical criteria and a transient
positive response to a prognostic blockade of the medial branch of the dorsal ramus of the thoracic spinal nerve. They were
selected to undergo percutaneous radiofrequency denervation of the facet joints. The short and long-term results of 51
percutaneous thoracic facet denervations in 40 patients are described. After 2 months, 19 patients (47.5%) were pain-free, 14
patients (35%) had more than 50% pain-relief, and 7 patients (17.5%) had no relief. After a follow-up of 18-54 (average 31)
months in 36 cases (3 patients had died because of malignancy, and 1 had undergone a spinal fusion), 16 patients (44%)
were pain-free, 14 patients (39%) had more than 50% pain-relief and in 6 cases (17%) the result was poor. Adverse effects
consisted of postoperative pain in 5 patients (12.5%). When conservative treatment fails, percutaneous thoracic facet
denervation can be a safe and beneficial therapy in chronic thoracic spinal pain originating from the facet joints.
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