J Korean Neurosurg Soc.  2014 Oct;56(4):338-343. 10.3340/jkns.2014.56.4.338.

The Effectiveness of Endoscopic Radiofrequency Denervation of Medial Branch for Treatment of Chronic Low Back Pain

• Jeong SY
• Kim JS
• Choi WS
• Hur JW
• Ryu KS

• KMID: 2018086
• DOI: http://doi.org/10.3340/jkns.2014.56.4.338

Abstract

OBJECTIVE
The aim of this study is to evaluate the clinical results of endoscopic radiofrequency ablation of medial branch in patients with chronic low back pain originating from facet joints.
METHODS
Between October 2010 and December 2013, 52 consecutive patients had suffering from chronic low back pain had undergone endoscopic radiofrequency denervation of medial branch of dorsal ramus. The clinical outcomes of these 52 patients were reviewed retrospectively. Preoperative and postoperative Visual Analogue Scale (VAS) and Korean version of Oswestry Disability Index (K-ODI), and patients' satisfaction with the procedure were assessed.
RESULTS
The pain scores on the VAS for back pain had improved significantly from a preoperative mean of 7.1 to a postoperative mean of 2 at the last follow-up (p<0.001). The clinical outcomes based on the K-ODI had also improved significantly from a preoperative mean of 26.5% to postoperative mean of 7.7% at the last follow-up (p<0.001). 80% of patients were satisfied with the procedure. There were no complications associated with the procedure.
CONCLUSION
Our preliminary results demonstrate that endoscopic radiofrequency denervation of medial branch could be an effective alternative treatment modality for chronic back pain originating from facet joints that provides long-term pain relief.

Keyword

Endoscopic radiofrequency; Chronic low back pain; Facet joint; Medial branch

MeSH Terms

Back Pain
Catheter Ablation
Denervation*
Follow-Up Studies
Humans
Low Back Pain*
Retrospective Studies
Zygapophyseal Joint

Figure

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  Fig. 1 The mean preoperative VAS score for back pain was 7.1, which improved to 2.0 at 24 months' follow-up (p<0.001) (A), and the patients' mean score on the K-ODI improved from 26.5% to 7.7% (p<0.001) by the 24 months' follow-up (B). VAS : Visual Analogue Scale, K-ODI : Oswestry Disability Index.

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  Fig. 2 Patients' satisfaction (A) and willingness to receive treatment again (B) were measured using questionnaire sheets with 4 point and 5 point scales, respectively.

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  Fig. 3 Non-contrast computed tomography (CT) image shows adjacent segment degeneration at L3-4 with diffuse bulging disc and bilaterally hypertrophied facets.

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  Fig. 4 Fluoroscopic images of L4 medial branch block. Same procedure was repeated for L3 medial branch, as L3-4 facet receives dual innervation from L3 and L4 medial branches.

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  Fig. 5 Intraprocedural fluoroscopic image showing cannula location during endoscopic RF denervation of L3 medial branch. First, 18 G needle was docked onto target point, at the junction of transverse process and superior articular process, and its position was confirmed on C-arm images. Then working cannula was inserted through the trajectory made by 18 G needle. RF : radiofrequency.

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  Fig. 6 Bipolar RF probe was used to denervate target medial branch once it was identified under endoscope. RF : radiofrequency.

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  Fig. 7 Endoscopic view shows medial branch of dorsal ramus (white arrow) as it courses caudally from the junction of transverse process and superior articular facet.

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