Journal of Spinal Disorders & Techniques. Volume 24(2), April 2011, p 69–75

Identifying Patients With Chronic Low Back Pain Likely to Benefit From Lumbar Facet Radiofrequency Denervation: A Prospective Study

Tomé-Bermejo, Félix MD*; Barriga-Martín, Andrés PhD†; Martín, Jose Luís R. PhD‡
Author Information
*Spine Unit, Department of Orthopaedic Surgery and Traumatology, Virgen de la Salud Hospital
†Department of Orthopaedic Surgery and Traumatology, National Paraplegic Hospital, Toledo
‡Department of Clinical Research, Foundation for Health Research in Castilla-La Mancha, Spain. © 2011 Lippincott Williams & Wilkins, Inc.

Study Design: Case series. Prospective study.

Objective: This is a prospective study of a group of patients with chronic low back facet joint pain, meticulously selected using a combination of clinical history, examination, imaging tests, and lumbar facet joint block with a local anesthetic, aimed at assessing the efficacy of treatment with percutaneous rhizolysis in reducing pain and improving related disability.

Summary of Background Data: Percutaneous radiofrequency facet joint denervation (rhizolysis) provides significant alleviation of pain and functional disability in patients with chronic low back pain of facet joint origin. However, accurate patient selection represents a clinical challenge. Patient selection based only on the result of diagnostic blocks may lead to disappointing results as the false-positive rate of the anesthetic diagnostic blocks is reported to be more than 30%.

Methods: A total of 86 patients (mean age, 49.87; mean duration of pain, 7.12 y) finally selected for treatment with rhizolysis were those who presented with chronic lumbar pain and a clinical history and examination with characteristics specific to facet joint pain; whose imaging tests ruled out a possible origin of pain other than the facet joints; and who finally responded favorably to facet joint block with a local lumbar anesthetic. All patients were clinically evaluated according to the indications of the Spanish Society for the Study of Diseases of the Spine (GEER). A follow-up of a minimum of 1 year was conducted.

Results: After rhizolysis, lumbar pain, measured by the visual analog scale and the Oswestry Low Back Pain Disability Questionnaire, improved significantly (P<0.05), with the reduction in disability due to lumbar pain being reflected in a notable improvement in the patients' quality of life. A total of 89% of patients experienced significant relief from pain after rhizolysis, with this relief lasting 6 months or more in 66%, and a minimum of 1 year in 50% of cases. At 1 year, 75.67% of patients stated that they would willingly undergo the same treatment again.

Conclusions: Rhizolysis is a valuable tool for the symptomatic treatment of chronic lumbar facet joint pain. A meticulous selection of patients using a combination of clinical history, examination, imaging tests, and lumbar facet joint block with a local anesthetic, achieves long-lasting results by helping reduce the impact on these patients' daily activities.