Adjunct facet radiofrequency ablation accelerates early recovery trajectories after lumbar Decompression: A prospective matched feasibility study.

Abstract

Introduction: While lumbar decompression is the standard of care for neurogenic claudication, adequate neural decompression does not address degenerative facet arthrosis, often resulting in residual axial pain that impedes early mobilization. The utility of adjunct facet radiofrequency ablation (RFA) in optimizing the immediate postoperative experience remains under-investigated.

Research question: We therefore hypothesized that adjunct RFA improves early recovery trajectories, observable only through high-frequency monitoring.

Methods: Forty patients undergoing decompression were included; 20 received adjunct bilateral facet RFA based on clinical indication. A post hoc 1:1 matched cohort (age, sex, operated levels) was created for analysis. Early recovery was tracked using a digital well-being scale (0-100) recorded every 48 h for 24 days. Trajectories were quantified using also standard disability (ODI) and mood (PHQ-9) assessments.

Results: Baseline characteristics were comparable (mean age 74.8 vs 75.4 years; baseline ODI 46.7 vs 46.4; baseline PHQ-9 8.8 vs 8.2). Early postoperative well-being was higher in the decompression + RFA group (mean 76.1 ± 9.4) than decompression alone (46.6 ± 11.3), with a paired mean difference of 29.5 points (95% CI, 22.3-36.6; p < 0.001). In mixed-effects trajectory modeling, adjunct RFA was associated with a higher estimated day-0 well-being score (+13.1; p = 0.005) and a steeper recovery slope (group×time +2.49 points/day; p < 0.001). Postoperative ODI was lower with adjunct RFA (26.1 vs 33.4; p = 0.20), while ODI change and PHQ-9 change were similar between groups.

Discussion and conclusions: Adjunct facet RFA significantly optimizes early postoperative well-being and accelerates recovery trajectories following lumbar decompression. By leveraging high-frequency monitoring, this study identifies benefits that standard follow-up intervals fail to capture.