STUDY DESIGN: Case series. Prospective study. OBJECTIVE: This is a prospective study of a group of patients with chronic low back facet joint pain, meticulously selected using a combination of clinical history, examination, imaging tests, and lumbar facet joint block with a local anesthetic, aimed at assessing the efficacy of treatment with percutaneous rhizolysis in reducing pain and improving related disability. SUMMARY OF BACKGROUND DATA: Percutaneous radiofrequency facet joint denervation (rhizolysis) provides significant alleviation of pain and functional disability in patients with chronic low back pain of facet joint origin. However, accurate patient selection represents a clinical challenge. Patient selection based only on the result of diagnostic blocks may lead to disappointing results as the false-positive rate of the anesthetic diagnostic blocks is reported to be more than 30%. METHODS: A total of 86 patients (mean age, 49.87; mean duration of pain, 7.12 y) finally selected for treatment with rhizolysis were those who presented with chronic lumbar pain and a clinical history and examination with characteristics specific to facet joint pain; whose imaging tests ruled out a possible origin of pain other than the facet joints; and who finally responded favorably to facet joint block with a local lumbar anesthetic. All patients were clinically evaluated according to the indications of the Spanish Society for the Study of Diseases of the Spine (GEER). A follow-up of a minimum of 1 year was conducted. RESULTS: After rhizolysis, lumbar pain, measured by the visual analog scale and the Oswestry Low Back Pain Disability Questionnaire, improved significantly (P<0.05), with the reduction in disability due to lumbar pain being reflected in a notable improvement in the patients' quality of life. A total of 89% of patients experienced significant relief from pain after rhizolysis, with this relief lasting 6 months or more in 66%, and a minimum of 1 year in 50% of cases. At 1 year, 75.67% of patients stated that they would willingly undergo the same treatment again. CONCLUSIONS: Rhizolysis is a valuable tool for the symptomatic treatment of chronic lumbar facet joint pain. A meticulous selection of patients using a combination of clinical history, examination, imaging tests, and lumbar facet joint block with a local anesthetic, achieves long-lasting results by helping reduce the impact on these patients' daily activities.
STUDY DESIGN: Case series. Prospective study. OBJECTIVE: This is a prospective study of a group of patients with chronic low back facet joint pain, meticulously selected using a combination of clinical history, examination, imaging tests, and lumbar facet joint block with a local anesthetic, aimed at assessing the efficacy of treatment with percutaneous rhizolysis in reducing pain and improving related disability. SUMMARY OF BACKGROUND DATA: Percutaneous radiofrequency facet joint denervation (rhizolysis) provides significant alleviation of pain and functional disability in patients with chronic low back pain of facet joint origin. However, accurate patient selection represents a clinical challenge. Patient selection based only on the result of diagnostic blocks may lead to disappointing results as the false-positive rate of the anesthetic diagnostic blocks is reported to be more than 30%. METHODS: A total of 86 patients (mean age, 49.87; mean duration of pain, 7.12 y) finally selected for treatment with rhizolysis were those who presented with chronic lumbar pain and a clinical history and examination with characteristics specific to facet joint pain; whose imaging tests ruled out a possible origin of pain other than the facet joints; and who finally responded favorably to facet joint block with a local lumbar anesthetic. All patients were clinically evaluated according to the indications of the Spanish Society for the Study of Diseases of the Spine (GEER). A follow-up of a minimum of 1 year was conducted. RESULTS: After rhizolysis, lumbar pain, measured by the visual analog scale and the Oswestry Low Back Pain Disability Questionnaire, improved significantly (P<0.05), with the reduction in disability due to lumbar pain being reflected in a notable improvement in the patients' quality of life. A total of 89% of patients experienced significant relief from pain after rhizolysis, with this relief lasting 6 months or more in 66%, and a minimum of 1 year in 50% of cases. At 1 year, 75.67% of patients stated that they would willingly undergo the same treatment again. CONCLUSIONS: Rhizolysis is a valuable tool for the symptomatic treatment of chronic lumbar facet joint pain. A meticulous selection of patients using a combination of clinical history, examination, imaging tests, and lumbar facet joint block with a local anesthetic, achieves long-lasting results by helping reduce the impact on these patients' daily activities.
Authors: Heather K Vincent; Kevin R Vincent; Amanda N Seay; Bryan P Conrad; Robert W Hurley; Steven Z George Journal: PM R Date: 2013-11-07 Impact factor: 2.298