Radiofrequency Ablation for Chronic Lumbar Zygapophyseal Joint Pain Using a V-Shaped Active Tip Needle: An Observational Retrospective Study

Abstract

Background

Lumbar zygapophyseal joint dysfunction represents one of the major sources of chronic low back pain. Radiofrequency ablation (RFA) using a V-shaped active tip needle may offer a larger lesion of the medial branch nerves, improving clinical outcome. The aim of our study is to evaluate the efficacy and the feasibility of RFA using V-shaped active tip needles.

Methods

This is a single-center observational retrospective study. Clinical records were screened and analyzed if they met the following inclusion criteria: adult patients (>18 years), diagnosis of chronic lumbar zygapophyseal joint pain, failure of conservative treatments, ability to provide informed consent for data analysis and publication. Exclusion criteria: lumbar pain not related to zygapophyseal joints, previous spinal/lumbar surgery, incomplete data, absence or withdrawal of informed consent. The primary outcome of the study was a change in pain intensity at follow-up. The secondary outcomes were the evaluation of quality-of-life improvement, the occurrence of adverse events and the impact on post-procedural analgesic consumption. For these purposes, pre- and post-treatment numeric rating scale (NRS), neuropathic pain 4 questions (DN4), EuroQoL - EQ-5D-3L, EQ-VAS, EQ-index and North American Spine Society (NASS) index were retrieved and analysed.

Results

Sixty-four patients were included. 7.8% of patients at 1-month (CI95% 0.026, 0.173), 37.5% at 3-month (CI95% 0.257, 0.505), 40.6% at 6-month (CI95% 0.285, 0.536) and 35.9% at 9-month (CI95% 0.243, 0.489) follow-up reported a reduction of more than 80% in NRS Statistical analysis indicated a significant change in NRS, DN4, EQ-index and EQ-5D-VAS (p-value <0.001) at the different time-points.

Conclusion

RFA using a V-shaped active tip needle might be a feasible and effective treatment for chronic lumbar zygapophyseal joint pain.

Keywords:

• arthralgia
• chronic pain
• zygapophyseal joint
• pain management
• radiofrequency ablation
• neuromodulation
• lumbar facet joint

Acknowledgement

We would like to thank the artist Andrea Lino for the drawings.

Author Contributions

Giuliano Lo Bianco: conceptualization, study design, execution, acquisition of data, writing (original draft); Giovanni Misseri: conceptualization, methodology, study design, data analysis and interpretation, writing (original draft); Agnes R Stogicza: methodology, data interpretation, writing (substantial and critical revision of the manuscript); Cesare Gregoretti: study design, writing (critical revision of the manuscript); Sean Li: methodology, writing (critical revision of the manuscript); Miles Day: data analysis and interpretation, writing (critical revision of the manuscript); David J Kennedy: study design, methodology, writing (substantial and critical revision of the manuscript); Michael E Schatman: methodology, data analysis and interpretation, writing (critical revision of the manuscript). All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

Dr Giuliano Lo Bianco reports consulting for Stryker, outside the submitted work. Dr Gregoretti Cesare reports personal fees from Philips, during the conduct of the study. Dr Sean Li reports grants, consultant, research grant from Abbott, Avanos, Averitas, Biotronik, Boston Scientific, Nevro, PainTeq, SPR Therapeutics; consultant, research grant, minority options from Nalu; consultant for Vertos and Pria Health; speaker bureau from Silex Pharma; grants from Ethos Laboratory, during the conduct of the study. Dr Michael E Schatman reports Research consultant for Modoscript and on Scientific Steering Committee for Collegium Pharmaceutical, outside the submitted work. The authors report no other conflicts of interest in this work.

Additional information

Funding

There is no funding to report.