A retrospective single arm cohort study evaluating the efficacy of lumbar medial branch radiofrequency ablation using a multi-tined probe and perpendicular approach

Abstract

Summary of background data

Lumbar medial branch radiofrequency ablation (LMBRFA) is an effective treatment for facet joint pain. LMBRFA efficacy was originally demonstrated using a parallel technique. Newly developed RFA probes (e.g., Trident) allow a perpendicular approach (P-LMBRFA), which may simplify the RFA technique and lead to superior treatment success rates. However, further investigation is necessary to determine whether these technologies are associated with improved patient outcomes.

Objectives

Evaluate the effectiveness of P-LMBRFA in patients with confirmed facet pain.

Methods

In this retrospective single-arm cohort study, electronic medical records were used to identify consecutive patients with ≥80 % dual medial branch block-confirmed pain relief who underwent first-time P-LMBRFA between 2016 and 2022. Primary outcomes were ≥50 % Numerical Rating Scale (NRS) pain improvement and the minimal clinically important difference (MCID) on the Pain Disability Quality-of-Life Questionnaire (PDQQ) at 3 months post-treatment. Secondary outcomes included the duration and mean retrospective percentage of pain relief after a successful index P-LMBRFA in individuals who reported a return of their index symptoms.

Results

174 participants (60.3 % female, 61.3 ± 14.2 years of age, BMI 29.5 ± 6.7 kg/m²) were analyzed. Success rates for ≥50 % NRS reduction and MCID on the PDQQ at 3 months were 50.6 % (95 % CI = 43.3–57.9 %) and 50.0 % (95 % CI = 42.8–57.2 %), respectively. Of the 88 successful P-LMBRFAs, 60 patients experienced a return of symptoms after 8.7 ± 3.6 months and reported a retrospective mean percentage pain relief of 81.8 % ± 15.8 %.

Discussion/conclusion

Following P-LMBRFA, approximately 50 % of patients reported improvement in pain and disability measures. Extensive, prospective research comparing long-term outcomes of P-LMBRFA and parallel LMRBFA is warranted.