56. Comparative study: platelet rich fibrin (PRF) vs radiofrequency medial ranch neurotomy (RF-MBN) for lumbar facet joint syndrome

Abstract

BACKGROUND CONTEXT

Lumbar facet joint syndrome is a prevalent cause of chronic lower back pain. Radiofrequency medial branch neurotomy (RF-MBN) alleviates pain by ablating the medial branch nerves but requires repeat procedures and may contribute to paraspinal muscle degeneration and spinal instability. Platelet-Rich Fibrin (PRF), an autologous regenerative therapy, promotes tissue healing without neural damage by releasing bioactive molecules that enhance cellular repair and neuroprotection. Unlike RF-MBN, PRF provides sustained pain relief, does not require sedation, and has no reported adverse effects.

PURPOSE

To compare the efficacy, duration of pain relief, and safety of PRF injections versus RF-MBN in the management of chronic lumbar facet joint syndrome.

STUDY DESIGN/SETTING

A retrospective cohort analysis was conducted on 160 patients diagnosed with chronic lumbar facet joint syndrome over a 10-year period. Patient records were reviewed to evaluate the outcomes of these standard clinical treatments, all performed under fluoroscopic guidance.

PATIENT SAMPLE

A total of 160 patients with confirmed lumbar facet joint syndrome were included based on clinical examination, imaging studies, and positive response to medial branch nerve blocks.

OUTCOME MEASURES

Primary outcome: Pain reduction at 12 months (VAS). Secondary outcomes: Functional improvement (ODI), adverse event rates, need for repeat procedures, and postprocedural complications. Safety outcomes included sedation-related side effects and paraspinal muscle degeneration.

METHODS

Patients were retrospectively categorized into two treatment groups: PRF Injection: Intra-articular PRF injection performed under fluoroscopic guidance every six months without sedation. RF-MBN: Medial branch nerve ablation performed under fluoroscopic guidance with sensory/motor threshold monitoring, requiring sedation, and repeated every six months.

RESULTS

Pain Relief: At 12 months, 82% of PRF patients reported >80% pain reduction compared to 60% in the RF-MBN group (p < 0.01, 95% CI: 75%-89%). Relief Duration: PRF provided sustained relief in 78% of patients beyond 12 months, while RF-MBN required repeat procedures after 10.2 months (p < 0.05, 95% CI: 72%-84%). Functional Improvement: ODI scores improved in 85% of PRF patients vs 65% in RF-MBN patients (p < 0.01, 95% CI: 78%-92%). Safety: PRF had no reported adverse events, whereas RF-MBN had a 7% complication rate, primarily transient pain flares and minor motor deficits. Sedation: PRF required no sedation, while 38% of RF-MBN patients experienced sedation-related side effects, prolonging recovery. Muscle Stability: No paraspinal muscle degeneration was observed in PRF patients, whereas RF-MBN patients demonstrated an increased risk of spinal instability due to nerve ablation.

CONCLUSIONS

PRF is a safe, effective, and longer-lasting treatment for lumbar facet joint syndrome, providing significant pain relief and functional improvement without the need for sedation or neural damage. Unlike RF-MBN, PRF preserves paraspinal muscle integrity, reducing the risk of spinal instability. As a retrospective study, selection bias and documentation inconsistencies may influence results. Future randomized controlled trials with larger sample sizes and extended follow-up periods are warranted to further validate these findings, optimize PRF application techniques, and assess its long-term impact on functional mobility and healthcare costs.

FDA Device/Drug Status

This abstract does not discuss or include any applicable devices or drugs.