The effectiveness of cervical medial branch radiofrequency neurotomy using a perpendicular approach with a three-tined probe: A single-arm, retrospective cohort study

Abstract

Background

Cervical medial branch radiofrequency neurotomy (CMBRFN) with a parallel approach has been proven to be an effective treatment for zygapophyseal joint-mediated cervical pain. Technological advancements in radiofrequency probe design have allowed for a perpendicular approach to electrode placement. However, the effectiveness of the perpendicular approach remains to be fully understood.

Objectives

Evaluate the effectiveness of CMBRFN with a perpendicular approach (pCMBRFN) in patients with confirmed zygapophyseal joint-mediated cervical pain.

Methods

This single-arm, retrospective cohort study included patients identified between 2016 and 2022 who underwent pCMBRFN after demonstrating ≥80 % pain relief with two consecutive diagnostic medial branch blocks (MBB). Primary outcomes were ≥50 % patient-reported numeric rating scale (NRS) pain relief and minimal clinically important difference (MCID) on the Pain Disability Quality-Of-Life Questionnaire-Spine (PDQQ-S) at 3 months post-procedure. Secondary outcomes were mean patient-reported retrospective percentage pain relief and duration of relief after a successful pCMBRFN in individuals who presented for repeat pCMBRFN upon return of their symptoms.

Results

A total of 52 participants (63.5 % female; mean age 55.9 ± 10.9 years; mean BMI 26.8 ± 5.2 kg/m²) were analyzed. At 3 months post-procedure, ≥50 % NRS pain reduction and MCID on PDQQ-S were both reported by 34 patients (65.4 % [95%CI 51.8–76.9]). Of the 34 patients with successful treatment response, 15 had return of symptoms after an average of 8.8 ± 2.5 months with a reported mean percentage pain relief of 86.0 ± 14.9 %.

Conclusion

Within this cohort, pCMBRFN demonstrated effectiveness by reducing pain and disability in over 65 % of patients with confirmed cervical zygapophyseal joint-mediated pain at 3 months. Patients with successful treatment outcomes whose index symptoms eventually returned reported an average pain reduction of 86 % lasting approximately 9 months. Larger prospective studies with long-term follow-up are needed to confirm these results.