Affiliation:
1. Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine , Salt Lake City, UT 84108, United States
2. University of California Los Angeles School of Medicine , Los Angeles, CA 90095, United States
3. Alabama College of Osteopathic Medicine , Dothan, AL, United States
Abstract
Abstract
Background
Lumbar medial branch radiofrequency ablation (LRFA) and intraarticular facet steroid injections (FJI) are commonly performed for recalcitrant facet joint-mediated pain. However, no study has compared clinical outcomes of the two treatments in patients selected using dual medial branch blocks (MBBs) with an 80% relief threshold.
Objective
Compare the effectiveness of cooled LRFA (C-LRFA) to FIJ as assessed by pain and functional improvements.
Design
Prospective randomized comparative trial.
Methods
Patients with dual MBB-confirmed facet joint-mediated pain were randomized to receive C-LRFA or FIJ. Outcomes were assessed at 1, 3, 6, and 12 months. The primary outcome was ≥50% improvement in numerical pain rating scale (NPRS) score at 3 months. Secondary outcomes included ≥30% Oswestry Disability Index (ODI) improvement and Patient Global Impression of Chance (PGIC) ≥6 points, among others. Data were analyzed using contingency tables and mixed-effects logistic regression models.
Results
Of 1128 patients screened, 32 met eligibility criteria, were randomized, and received their allocated study treatment. In total, 20 (62.5%) and 12 (37.5%) participants received C-LRFA and FIJ, respectively. In the C-LRFA group, 70% (95% CI 48–85), 55% (95% CI 34–74), and 45% (95% CI 26–66) of participants met the NPRS responder definition, compared to 25% (95%CI 9–53), 25% (95% CI 9–53), and 17% (95% CI 5–45) in the FJI group at 3, 6, and 12 months, respectively (P = .014 at 3 months). The PGIC responder proportion was higher in the C-LRFA compared to FJI group at 3 and 6 months (P < .05).
Conclusions
C-LRFA demonstrated superior success rates compared to FJI across pain and functional outcome domains.
Trial registration details
ClinicalTrials.gov (NCT03614793); August 3, 2018.
Funder
Avanos Medical
University of Utah Carol and Leonard Raizin Spine Research
University of Utah Judith Victor Spine Research
Publisher
Oxford University Press (OUP)
Subject
Anesthesiology and Pain Medicine,Neurology (clinical),General Medicine
Reference41 articles.
1. The State of US health, 1990–2010: burden of diseases, injuries, and risk factors;Murray;JAMA,2013
2. US health care spending by payer and health condition, 1996–2016;Dieleman;JAMA,2020
3. Multivariable analyses of the relationships between age, gender, and body mass index and the source of chronic low back pain;DePalma;Pain Med,2012
4. Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain;Cohen;Anesthesiology,2007
5. Facet joint osteoarthritis and low back pain in the community-based population;Kalichman;Spine (Phila Pa 1976),2008
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