The Effectiveness of Cervical Medial Branch Thermal Radiofrequency Neurotomy Stratified by Selection Criteria: A Systematic Review of the Literature

Pain Medicine ◽  
2020 ◽  
Vol 21 (11) ◽  
pp. 2726-2737
Author(s):  
Andrew Engel ◽  
Wade King ◽  
Byron J Schneider ◽  
Belinda Duszynski ◽  
Nikolai Bogduk
Keyword(s):  
Systematic Review ◽  
Pain Relief ◽  
Evaluation System ◽  
Selection Criteria ◽  
Cervicogenic Headache ◽  
Primary Outcome Measure ◽  
Outcome Data ◽  
Complete Relief ◽  
Medial Branch ◽  
Radiofrequency Neurotomy

Abstract Objective To determine the effectiveness of cervical medial branch thermal radiofrequency neurotomy in the treatment of neck pain or cervicogenic headache based on different selection criteria. Design Comprehensive systematic review. Methods A comprehensive literature search was conducted, and the authors screened and evaluated the studies. The Grades of Recommendation, Assessment, Development, and Evaluation system was used to assess all eligible studies. Outcome Measures The primary outcome measure assessed was the success rate of the procedure, defined by varying degrees of pain relief following neurotomy. Data are stratified by number of diagnostic blocks and degree of pain relief. Results Results varied by selection criteria, which included triple placebo-controlled medial branch blocks, dual comparative medial branch blocks, single medial branch blocks, intra-articular blocks, physical examination findings, and symptoms alone. Outcome data showed a greater degree of pain relief more often when patients were selected by triple placebo-controlled medial branch blocks or dual comparative medial branch blocks, producing 100% relief of the index pain. The degree of pain relief was similar when triple or dual comparative blocks were used. Conclusions Higher degrees of relief from cervical medial branch thermal radiofrequency neurotomy are more often achieved, to a statistically significant extent, if patients are selected on the basis of complete relief of index pain following comparative diagnostic blocks. If selected based on lesser degrees of relief, patients are less likely to obtain complete relief.

Systematic Review of the Effectiveness of Lumbar Medial Branch Thermal Radiofrequency Neurotomy, Stratified for Diagnostic Methods and Procedural Technique

Pain Medicine ◽  
2020 ◽  
Vol 21 (6) ◽  
pp. 1122-1141 ◽  
Author(s):  
Byron J Schneider ◽  
Lisa Doan ◽  
Marc K Maes ◽  
Kevin R Martinez ◽  
Alan Gonzalez Cota ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pain Relief ◽  
Patient Selection ◽  
Evaluation System ◽  
Selection Criteria ◽  
Diagnostic Methods ◽  
Electrode Placement ◽  
Medial Branch ◽  
Radiofrequency Neurotomy ◽  
Parallel Electrode

Abstract Objective To determine the effectiveness of lumbar medial branch thermal radiofrequency neurotomy based on different selection criteria and procedural techniques. Design Comprehensive systematic review. Methods A comprehensive literature search was conducted, and all authors screened and evaluated the studies. The Grades of Recommendation, Assessment, Development, and Evaluation system was used to assess all eligible studies. Outcome Measures The primary outcome measure assessed was the success rate of the procedure, defined by varying degrees of pain relief following neurotomy. Data are stratified by number of diagnostic blocks and degree of pain relief, as well as procedural technique with perpendicular or parallel placement of electrodes. Results Results varied by selection criteria and procedural technique. At six months, 26% of patients selected via single medial branch block with 50% pain relief and treated via perpendicular technique achieved at least 50% pain relief; 49% of patients selected via dual medial branch blocks with 50% pain relief and treated via parallel technique achieved at least 50% pain relief. The most rigorous patient selection and technique—two diagnostic medial branch blocks with 100% pain relief and parallel electrode placement—resulted in 56% of patients experiencing 100% relief of pain at six months. Conclusions This comprehensive systematic review found differences in the effectiveness of lumbar medial branch radiofrequency neurotomy when studies were stratified by patient selection criteria and procedural technique. The best outcomes are achieved when patients are selected based on high degrees of pain relief from dual medial branch blocks with a technique employing parallel electrode placement.

scholarly journals Bilateral Intra-Articular Radiofrequency Ablation for Cervicogenic Headache

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Charles A. Odonkor ◽  
Teresa Tang ◽  
David Taftian ◽  
Akhil Chhatre
Keyword(s):  
Radiofrequency Ablation ◽  
Pain Relief ◽  
Symptomatic Relief ◽  
Cervicogenic Headache ◽  
Term Treatment ◽  
Medial Branch ◽  
Neck Stiffness ◽  
Intervertebral Disks ◽  
Long Term Treatment ◽  
Improved Function

Introduction. Cervicogenic headache is characterized by unilateral neck or face pain referred from various structures such as the cervical joints and intervertebral disks. A recent study of patients with cervical pain showed significant pain relief after cervical medial branch neurotomy but excluded patients with C1-2 joint pain. It remains unclear whether targeting this joint has potential for symptomatic relief. To address this issue, we present a case report of C1-2 joint ablation with positive outcomes. Case Presentation. A 27-year-old female presented with worsening cervicogenic headache. Her pain was 9/10 by visual analog scale (VAS) and described as cramping and aching. Pain was localized suboccipitally with radiation to her jaw and posterior neck, worse on the right. Associated symptoms included clicking of her temporomandibular joint, neck stiffness, bilateral headaches with periorbital pain, numbness, and tingling. History, physical exam, and diagnostic studies indicated localization to the C1-2 joint with 80% decrease in pain after C1-2 diagnostic blocks. She underwent bilateral intra-articular radiofrequency ablation of the C1-C2 joint. Follow-up at 2, 4, 8, and 12 weeks showed improved function and pain relief with peak results at 12 weeks. Conclusion. Clinicians may consider C1-C2 joint ablation as a viable long-term treatment option for cervicogenic headaches.

scholarly journals Systematic Review of the Therapeutic Effectiveness of Cervical Facet Joint Interventions: An Update

2012 ◽  
Vol 6;15 (6;12) ◽  
pp. E839-E868 ◽  
Author(s):  
Frank J.E. Falco
Keyword(s):  
Systematic Review ◽  
Neck Pain ◽  
Joint Pain ◽  
Observational Studies ◽  
Facet Joint ◽  
Medial Branch ◽  
Radiofrequency Neurotomy ◽  
Facet Joint Interventions ◽  
Cervical Facet ◽  
Cervical Facet Joint

Background: The prevalence of chronic, recurrent neck pain is approximately 15% of the adult general population. Controlled studies have supported the existence of cervical facet or zygapophysial joint pain in 36% to 67% of these patients, when disc herniation, radiculitis, and discogenic are not pathognomic. However, these studies also have shown false-positive results in 27% to 63% of the patients with a single diagnostic block. There is also a paucity of literature investigating therapeutic interventions of cervical facet joint pain. Study Design: Systematic review of therapeutic cervical facet joint interventions. Objective: To determine and update the clinical utility of therapeutic cervical facet joint interventions in the management of chronic neck pain. Methods: The available literature for utility of facet joint interventions in therapeutic management of cervical facet joint pain was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria as utilized for interventional techniques for randomized trials and the criteria developed by the Newcastle-Ottawa Scale criteria for observational studies. The level of evidence was classified as good, fair, and limited or poor based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to June 2012, and manual searches of the bibliographies of known primary and review articles. Outcome Measures: The primary outcome measure was pain relief (short-term relief = up to 6 months and long-term > 6 months). Secondary outcome measures were improvement in functional status, psychological status, return to work, and reduction in opioid intake. Results: In this systematic review, 32 manuscripts were considered for inclusion. For final analysis, 4 randomized trials and 6 observational studies met the inclusion criteria and were included in the evidence synthesis. Based on one randomized, sham-controlled, double-blind trial and 5 observational studies, the indicated evidence for cervical radiofrequency neurotomy is fair. Based on one randomized, double-blind, active-controlled trial and one prospective evaluation, the indicated evidence for cervical medial branch blocks is fair. Based on 2 randomized controlled trials, the evidence for cervical intraarticular injections is limited. Limitations: Paucity of the overall published literature and specifically lack of literature for intraarticular cervical facet joint injections. Conclusions: The indicated evidence for cervical radiofrequency neurotomy is fair. The indicated evidence for cervical medial branch blocks is fair. The indicated evidence for cervical intraarticular injections with local anesthetic and steroids is limited. Key words: Chronic neck pain, cervical facet or zygapophysial joint pain, cervical medial branch blocks, cervical radiofrequency neurotomy, cervical intraarticular facet joint injections

scholarly journals An Update of Evaluation of Therapeutic Thoracic Facet Joint Interventions

2012 ◽  
Vol 4;15 (4;8) ◽  
pp. E463-E481
Author(s):  
Frank J.E. Falco
Keyword(s):  
Systematic Review ◽  
Back Pain ◽  
Quality Assessment ◽  
Joint Pain ◽  
Facet Joint ◽  
Medial Branch ◽  
Facet Joints ◽  
Nerve Blocks ◽  
Radiofrequency Neurotomy ◽  
Facet Joint Interventions

Background: Chronic mid back and upper back pain caused by thoracic facet joints has been reported in 34% to 48% of patients based on responses to controlled diagnostic blocks. Systematic reviews have established moderate evidence for controlled comparative local anesthetic blocks of thoracic facet joints in the diagnosis of mid back and upper back pain, moderate evidence for therapeutic thoracic medial branch blocks, and limited evidence for radiofrequency neurotomy of thoracic medial branches. Study Design: Systematic review of therapeutic thoracic facet joint interventions. Objective: To determine the clinical utility of therapeutic thoracic facet joint interventions in the therapeutic management of chronic upper back and mid back pain. Methods: The available literature for the utility of facet joint interventions in the therapeutic management of thoracic facet joint pain was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria as utilized for interventional techniques for randomized trials and the criteria developed by the Newcastle-Ottawa Scale criteria for observational studies. The level of evidence was classified as good, fair, and limited (or poor) based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to March 2012, and manual searches of the bibliographies of known primary and review articles. Outcome Measures: The primary outcome measure was pain relief (short-term relief = up to 6 months and long-term > 6 months). Secondary outcome measures were improvement in functional status, psychological status, return to work, and reduction in opioid intake. Results: For this systematic review, 13 studies were identified. Of these, 7 studies were excluded, and a total of 4 studies (after removal of duplicate publication) met inclusion criteria for methodological quality assessment with one randomized trial and 3 non-randomized studies. The evidence is fair for therapeutic thoracic facet joint nerve blocks, limited for thoracic radiofrequency neurotomy, and not available for thoracic intraarticular injections. Limitations: The limitation of this systematic review includes a paucity of literature. The only positive studies were of medial branch blocks performed by the same group of authors. Conclusion: The evidence for therapeutic facet joint interventions is fair for medial branch blocks, whereas it is not available for intraarticular injections, and limited for radiofrequency neurotomy due to lack of literature. Key words: Chronic thoracic pain, mid back or upper back pain, thoracic facet or zygapophysial joint pain, facet joint nerve blocks, medial branch blocks, therapeutic thoracic medial branch blocks, thoracic radiofrequency neurotomy, thoracic intraarticular facet joint injections

scholarly journals Bipolar Radiofrequency Neurotomy to Treat Neck and Back Pain in Patients with Automatic Implantable Cardioverter Defibrillator

2016 ◽  
Vol 3;19 (3;3) ◽  
pp. E505-E509 ◽  
Author(s):  
Alexander Bautista
Keyword(s):  
Back Pain ◽  
Pain Relief ◽  
Medial Branch ◽  
Facet Joints ◽  
Cardioverter Defibrillator ◽  
Radiofrequency Neurotomy ◽  
Bipolar Radiofrequency ◽  
Automatic Implantable Cardioverter Defibrillator ◽  
Lumbar Facet ◽  
Lumbar Facet Joints

We report 2 cases of successful treatment of neck and back pain with bipolar radiofrequency ablation (RFA) of the cervical and lumbar facet joints in patients with an automatic implantable cardioverter defibrillator (AICD). Two patients with complex cardiac histories and AICD devices were treated with bipolar RFA of the facet joints. One presented with axial neck pain and the other with axial back pain. The histories and physical examinations were consistent with facetogenic pain. Diagnostic medial branch block resulted in more than 70% pain relief lasting for several days, allowing patients to perform routine daily activities without significant pain. However, we were concerned about the use of conventional RFA of the medial branches of nerves for the fear of interference with the function of AICD by the RF currents and energy. We took advantage of the localized and limited current of bipolar RFA to perform this procedure for the cervical or lumbar facet joints avoiding any interference with the function of AICD. The procedures provided long-term pain relief to the patients, and marked improvement in their functional status without any evident complications related to the function of their AICD. This case report describes the safe and successful completion of bipolar RFA of the medial branch nerves to treat cervical and lumbar facetogenic pain in patients with AICD. This modality of treatment may be considered in patients with AICD. We are finding it to be increasingly common that patients who present with chronic neck and back pain have AICDs in place. Key words: Back pain, neck pain, facet, AICD, radiofrequency neurotomy, bipolar lesioning

scholarly journals A Systematic Review of Therapeutic Facet Joint Interventions in Chronic Spinal Pain

2007 ◽  
Vol 1;10 (1;1) ◽  
pp. 229-253
Author(s):  
Mark V. Boswell
Keyword(s):  
Pain Relief ◽  
Facet Joint ◽  
Spinal Pain ◽  
Medial Branch ◽  
Short Term ◽  
Radiofrequency Neurotomy ◽  
Short And Long Term ◽  
Facet Joint Interventions ◽  
Joint Injections

Background: Facet joints are considered to be a common source of chronic spinal pain. Facet joint interventions, including intraarticular injections, medial branch nerve blocks, and neurotomy (radiofrequency and cryoneurolysis) are used to manage chronic facet-mediated spinal pain. A systematic review of therapeutic facet interventions published in January 2005, concluded that facet interventions were variably effective for short-term and long-term relief of facet joint pain. Objective: To provide an updated evaluation of the effectiveness of 3 types of facet joint interventions in managing chronic spinal pain. Study Design: A systematic review utilizing criteria established by the Agency for Healthcare Research and Quality (AHRQ) for evaluation of randomized and non-randomized trials and the Cochrane Musculoskeletal Review Group for randomized trials. Methods: Data sources included relevant literature of the English language identified through searches of MEDLINE and EMBASE (November 2004 to December 2006) and manual searches of bibliographies of known primary and review articles within the last 2 years. Results of the analyses were performed for the different modes of facet joint interventions for the cervical, thoracic and lumbar spine, to determine short- and long-term outcome measurements and complications associated with these procedures. Outcome Measures: The primary outcome measure was pain relief. For intraarticular facet joint injections and medial branch blocks, short-term pain relief was defined as relief lasting less than 6 weeks and long-term relief as 6 weeks or longer. For medial branch blocks, repeated injections at defined intervals provided long-term pain relief. For medial branch radiofrequency neurotomy, short-term pain relief was defined as relief lasting less than 3 months and long-term relief as lasting 3 months or longer. Other outcome measures included functional improvement, improvement of psychological status, and return to work. Results: For cervical intraarticular facet joint injections, the evidence is limited for short- and long-term pain relief. For lumbar intraarticular facet joint injections, the evidence is moderate for short- and long-term pain relief. For cervical, thoracic, and lumbar medial branch nerve blocks with local anesthetics (with or without steroids), the evidence is moderate for short- and longterm pain relief with repeat interventions. The evidence for pain relief with radiofrequency neurotomy of cervical and lumbar medial branch nerves is moderate for short- and long-term pain relief, and indeterminate for thoracic facet neurotomy. Conclusion: With intraarticular facet joint injections, the evidence for short- and long-term pain relief is limited for cervical pain and moderate for lumbar pain. For medial branch blocks, the evidence is moderate for short- and long-term pain relief. For medial branch neurotomy, the evidence is moderate for short- and long-term pain relief. Key words: Spinal pain, neck pain, low back pain, facet or zygapophysial joints, intraarticular facet joint injections, medial branch blocks, therapeutic medial branch blocks, radiofrequency neurotomy, cryodenervation.

scholarly journals P-P08 Towards effective analgesia in acute pancreatitis: a systematic review of randomised controlled trials

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Navamayooran Thavanesan ◽  
Sophie White ◽  
Shiela Lee ◽  
Bathiya Ratnayake ◽  
John Leeds ◽  
...  
Keyword(s):  
Systematic Review ◽  
Acute Pancreatitis ◽  
Pain Relief ◽  
Meta Analysis ◽  
Local Anaesthetics ◽  
Primary Outcome Measure ◽  
Significant Heterogeneity ◽  
Epidural Administration ◽  
Global Improvement ◽  
Pain Scores

Abstract Background The optimal analgesic strategy for patients with acute pancreatitis (AP) remains unknown. The present systematic review and meta-analysis aims to compare the efficacy of several analgesic modalities trialled in AP. Methods A systematic search of PubMed, MEDLINE and EMBASE was conducted up until June 2021, according to PRISMA Guidelines to identify all randomised control trials (RCTs) comparing analgesic modalities in AP.  The primary outcome measure was improvement in pain scores as reported on visual analogue scale (VAS) on day 0, day 1 and day 2. Results Twelve RCTs were identified including 542 patients. Seven trial drugs were compared: opiates, non-steroidal anti-inflammatories (NSAIDs), placebo, local anaesthetic, epidural, paracetamol and metamizole. A weighted single-arm effects estimate showed global improvement in VAS across all modalities from baseline to day 2. On visual inspection, epidural analgesia appears to provide the greatest improvement in pain scores within the first 24hrs, however at 48hrs it was comparable to opiates. Within the first 24hrs, NSAIDs offered similar pain-relief to opiates, while placebo also showed equivalence to other modalities but then plateaued. Local anaesthetics demonstrated least overall efficacy. VAS scores for opiate and non-opiate analgesics were comparable at baseline and day 1. The identified RCTs demonstrated significant heterogeneity in pain-relief reporting with relatively small datasets per study. Conclusions Given the incidence of AP there is remarkable paucity of level 1 evidence to guide pain management. Epidural administration is most effective analgesic modality within the first 24hrs of AP. NSAIDs are an effective opiate sparing alternative during the first 24hrs.

scholarly journals Systematic Review of Cervical Medial Branch Thermal Radiofrequency Neurotomy is not Based on Peer Review Published Methodology

Pain Medicine ◽  
2016 ◽  
Vol 17 (9) ◽  
pp. 1779-1781 ◽  
Author(s):  
Laxmaiah Manchikanti ◽  
Alan David Kaye ◽  
Joshua A. Hirsch
Keyword(s):  
Systematic Review ◽  
Peer Review ◽  
Medial Branch ◽  
Radiofrequency Neurotomy

scholarly journals What is the Correlation Between Facet Joint Radiofrequency Outcome and Response to Comparative Medial Branch Blocks?

2016 ◽  
Vol 3;19 (3;3) ◽  
pp. 163-172 ◽  
Author(s):  
Sara Christensen Holz
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pain Relief ◽  
Facet Joint ◽  
Medial Branch ◽  
Low Back ◽  
Percent Change ◽  
Radiofrequency Neurotomy ◽  
Pain Clinics ◽  
Analgesic Use

Background: Facet joint pain is a common cause of low back pain. There are no physical exam findings that provide a reliable diagnosis. Diagnosis is made by medial branch block injections (MBB). Once the source of pain has been determined, radiofrequency neurotomy (RFN) can be performed. Previous studies have shown that RFN reduces level of pain and improves function. No study has tried to correlate MBB results with outcomes after RFN. Objectives: (1) Estimate percentage decrease in pain, decrease in analgesic use, and increase in activity tolerance after facet joint radiofrequency neurotomy (2) Determine correlation between percentage pain relief or duration of pain relief after MBB and RFN outcomes. Study Design: Retrospective review of patients undergoing RFN, who had ≥ 70% pain relief on 2 sets of MBB with 0.5 – 1 mL of 2% lidocaine (MBB 1) and 0.75% bupivacaine (MBB 2). IRB approval was obtained before data collection began. Setting: All patients undergoing RFN between 12/06-1/10 at University Spine and Pain clinics. Methods: Subgroup analysis was performed based on response to MBB, a)100% pain relief and <100% pain relief after MBB 1 and 2 and a) those with > 8 hours and ≤ 8 hours pain relief after MBB 1 and 2. Correlational analysis was conducted to determine the correlation between a) percent pain relief after MBB1 and 2 and percent change in pain after RFN and b) duration of pain relief after MBB 1 and 2 and percent change in pain relief after RFN. Outcome measures: Pain intensity, disability index, analgesic use, and patient perception of benefit. Results: Mean improvement of Disability scores at 3 months was 12.63 (P = 0.001), percent pain relief was 47.68% (P = 0.001). Patients with 100% pain relief after MBB 1 had greater improvement of disability scores (P = 0.008). Those with > 8 hours pain relief after MBB 1 had greater reduction in pain (P = 0.014). Pearson correlation analysis showed no correlation between percent pain relief or duration of pain relief after MBB and percent pain relief after RFN. Limitations: This was a small observational study with short-term follow up. Conclusion: Patients had improved disability scores and decreased pain after RFN. No correlation was seen between results on MBB and pain relief after RFN. It is still unclear how many medial branch blocks are needed and the criteria for MBB results before proceeding to RFN. Key words: Facet, medial branch blocks, radiofrequency ablation, chronic low back pain, interventional spine procedures, functional improvement

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