Radi ofrequency Therapy of Lumbar Facet Pain

Česká verzia

Authors: T. Gabrhelík ¹; M. Adamus ¹; M. Pi eran ¹; P. Michálek ²; E. Berta ¹
Authors place of work: Klinika anestezi ologi e a resuscitace LF UP a FN Olomo uc, 2Department of Anaesthetics, AntrimAre a Hospital, United Kingdom ¹
Published in the journal: Cesk Slov Neurol N 2009; 72/105(2): 125-131
Category: Original Paper

Summary

Backgro und:
The aim of this study was to evalu ate the efficacy and side effects of radi ofrequency lumbar facet dennervati on.

Methods:
Percutane o us minimal invasive spinal interventi ons bring new prospects for the pati ents with spinal pain refractory to conservative tre atment. The radi ofrequency pain tre atment is most commonly used technique when nervo us tissue is affected by an alternating electric fi eld of high frequency. We enrolled in total 76 pati ents who underwent radi ofrequency facet dennervati on. The success rate of procedure was evalu ated by observati on of pain intensity according to Visu al Analogue Scale, by qu antificati on of analgesic medicati on according to Medicati on Qu antificati on Scale and also by pati ent’s disability assessment due to pain according to Oswestry Disability Index three and 12 months after therapy.

Results:
Significant decre ase in pain intensity (p < 0.001) according to Visu al Analogue Scale both three months (3.0 ± 1.9) and 12 months after the therapy (3.6 ± 1.8) was observed compared to the pre‑procedure level (6.1 ± 1.3). The consumpti on of analgesic medicati on according to Medicati on Qu antificati on Scale before the therapy (11.2 ± 3.6) significantly dropped at three months (7.3 ± 5.0, p < 0.001) and 12 months (9.3 ± 7.1, p < 0.05), respectively. Common daily functi ons disability according to Oswestry Disability Index were significantly reduced both three (24 ± 7%, p < 0.001) and 12 months (26 ± 7%, p < 0.01) compared to initi al value (32 ± 5%). No seri o us complicati on was noted.

Conclusi ons:
Radi ofrequency lumbar facet dennervati on is effective and safe technique. The procedure is commonly followed by reducti on in chronic analgesic medicati on.

Key words:
back pain – minimal invasive interventi ons – radi ofrequency thermo ablati on – facet dennervati on

Zdroje

1. Spitzer WO, LeBlanc FE, Dupuis M. Sci entific appro ach to the assesment and management of activity‑related spinal disorders. Report of the Quebec Task Force on Spinal disorders. Spine 1987; 12 (Suppl 7): S1– S59.

2. Masqueli er E, le Polain B, Vissers K, Crombez G, De Laat A. Rugpijn in Belgi e: een epidemi ologische enquete. Newsletter Belgi an Pain Soci ety 2002: 11.

3. van Zundert J, Raj P, Erdine S, van Kleef M. Applicati on of radi ofrequency tre atment in practical pain management: state of the art. Pain Practice 2002; 2(3): 269– 278.

4. Manchikanti L, Manchikanti KN, Manchukonda R,Cash KA, Damron KS, Pampati V et al. Evalu ati on of lumbar facet jo int nerve blocks in the management of chronic low back pain: preliminary report of a randomized, do uble- blind controlled tri al: clinical tri al NCT00355914. Pain Physici an 2007; 10(3): 425– 440.

5. Sluijter ME. Mechanisms of back pain and sci atica. Abstracts of The First Maastricht Workshop on Radi ofrequency in the tre atment of spinal pain 1997: 70.

6. Fukui S, Ohseto K, Shi otani M, Ohno K, Karasawa H,Naganuma Y. Distributi on of referred pain from the lumbar zygo apophyse al jo ints and dorsal rami. Clin J Pain 1997; 13(4): 303– 307.

7. Jensen MC, Brant- Zawadzki MN, Obuchowski N, Modic MT, Malkasi an D, Ross JS. Magnetic resonance imaging of the lumbar spine in pe ople witho ut back pain. New Engl J Med 1994; 331(20): 69– 73.

8. She aly CN. Percutane o us radi ofrequency denervati on of spinal facets. Tre atment for chronic back pain and sci atica. J Ne urosurg 1975; 43(4): 448– 451.

9. Sluijter ME. Radi ofrequency, part I. Meggen: FlivoPress SA 2001.

10. Sluijter ME, van Kleef M. Characteristics and mode of acti on of radi ofrequency lesi ons. Curr Rev Pain 1998; 2: 143– 50.

11. Marks RC, Ho uston T, Thulbo urne T. Facet jo int injecti on and facet nerve block: a randomised comparison in 86 pati ents with chronic low back pain. Pain 1992; 49(3): 325– 328.

12. Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine 2000; 25(22): 2940– 2952.

13. Harden RN, Weinland SR, Remble TA, Ho ule TT, Coli o S, Steedman S et al. Medicati on Qu antificati on Scale Versi on III: update in medicati on classes and revised detriment weights by survey of American Pain Soci ety Physici ans. J Pain 2005; 6(6): 364– 371.

14. Ackerman WE jr, Ahmad M. Pain reli ef with intraarticular or medi al branch nerve blocks in pati ents with positive lumbar facet jo int SPECT imaging: a 12- week o utcome study. So uth Med J 2008; 101(9): 931– 934.

15. Manchikanti L, Singh V, Falco FJ, Cash KA, Pampati V.Lumbar facet jo int nerve blocks in managing chronic facet jo int pain: one- ye ar follow‑up of a randomized, do uble- blind controlled tri al. Pain Physici an 2008; 11(2): 121– 132.

16. Tzaan WC, Tasker RR. Percutane o us radi ofrequency facet rhizotomy-experi ence with 118 procedures and re appraisal of its value. Can J Ne urol Sci 2000; 27(2): 125– 130.

17. Sanders M. Applicati on of radi ofrequency lesi ons in pati ents suffering from chronic pain. Thesis Vrije Universiteit Amsterdam 1998: 77– 86.

18. Leclaire R, Fortin L, Lambert R, Bergeron YM, Rossignol M. Radi ofrequency facet jo int denervati on in the tre atment of low back pain: a placebo- controlled clinical tri al to assess efficacy. Spine 2001; 26(13): 1411– 1416.

19. van Wijk RM, Ge urts JW, Wynne HJ, Hammink E,Buskens E, Lo usberg R et al. Radi ofrequency denervati on of lumbar facet jo ints in the tre atment of chronic low back pain: a randomized, do uble- blind, sham lesi on- controlled tri al. Clin J Pain 2005; 21(4): 335– 344.

20. Van Kleef M, Barendse GA, Kessels A, Voets HM, Weber WE, de Lange S. Randomized tri al of radi ofrequency lumbar facet denervati on for chronic low back pain. Spine 1999; 24(18): 1937– 1942.

21. Gofeld M, Jitendra J, Facli er G. Radi ofrequency denervati on of the lumbar zygapophyse al jo ints: 10- ye ar prospective clinical a udit. Pain Physici an 2007; 10(2): 291– 300.

22. Nath S, Nath CA, Pettersson K. Percutane o us lumbar zygapophyse al (facet) jo int ne urotomy using radi ofrequency current, in the management of chronic low back pain: a randomized do uble-blind tri al. Spine 2008; 33(12): 1291– 1297.

23. Schofferman J, Kine G. Effectiveness of repe ated radi ofrequency ne urotomy for lumbar facet pain. Spine 2004; 29(21): 2471– 2473.

24. North RB, Han M, Zahurak M, Kidd DH. Radi ofrequency lumbar facet denervati on: analysis of prognostic factors. Pain 1994; 57(1): 77– 83.

25. Slipman CW, Bhat AL, Gilchrist RV, Issac Z, Cho u L,Lenrow DA. A critical revi ew of the evidence for the use of zygapophyse al injecti ons and radi ofrequency denervati on in the tre atment of low back pain. Spine J 2003; 3(4): 310– 316.

26. Ni emisto L, Kalso E, Malmivaara A, Seitsalo S, Hurri H.Radi ofrequency denervati on for neck and back pain. A systematic revi ew of randomized controlled tri als. Cochrane Database Syst Rev 2003; 1: CD004058.

27. van Boxem K, van Eerd M, Brinkhuize T, Patijn J, van Kleef M, van Zundert J. Radi ofrequency and pulsed radi ofrequency tre atment of chronic pain syndromes: the available evidence. Pain Pract 2008; 8(5): 385– 393.

28. Gabrhelík T, Michálek P. Radi ofrekvenční léčba bolesti. Anest intenziv Med 2004; 15(4): 197– 203.