Research ArticleCervical Spine

Single Entry Posterior Parasagittal Approach Radiofrequency Neurotomy of Cervical Medial Branch: A Feasible Alternative to Conventional Approaches in the Treatment of Cervical Facet Pain

Chee Kean Chen, Chung Chek Wong, Yian Young Teo and Vui Eng Phui
International Journal of Spine Surgery December 2021, 15 (6) 1192-1200; DOI: https://doi.org/10.14444/8151

Article Figures & Data

Figures

  • Figure 1
    Figure 1

    The posterolateral radiofrequency (RF) neurotomy of cervical medial branch. (A) Lateral fluoroscopic view with the RF cannula at C4 anterior portion of articular pillar. (B) Oblique fluoroscopic view with the RF cannula at a safe distance from the neural foramen. (C) Anteroposterior fluoroscopic view with the RF cannula at the waist of the articular pillar.

  • Figure 2
    Figure 2

    Surface markings with a horizontal line denoting the first segment of medial branch to be treated, vertical line denoting the lateral border of vertebral body. The intersection of these 2 lines is the needle entry point.

  • Figure 3
    Figure 3

    The single entry posterior parasagittal radiofrequency (RF) neurotomy of cervical medial branch. (A) Anteroposterior fluoroscopic view with the RF cannula at the waist of C5 vertebral body. (B) Lateral fluoroscopic view with the RF cannula at the final position of C5 articular pillar. (C) Lateral fluoroscopic view with the RF cannula at the final position of C4 articular pillar. (D) Lateral fluoroscopic view with the RF cannula at the final position of C3 articular pillar.

  • Figure 4
    Figure 4

    Flow diagram for patient inclusion. RF, radiofrequency.

Tables

  • Table 1

    Baseline demographic characteristics of patients.

    VariablesPosterolateral
    Approach (n = 31)    		Posterior Parasagital
    Approach (n = 40)    		 P Value
    Age, y47.35 ± 10.1147.50 ± 7.530.947
    Gender, Female19 (61)22 (55)0.595
    Weight, kg66.35 ± 10.7168.83 ± 12.430.381
    Height, cm161.52 ± 9.88162.95 ± 9.910.547
    Body mass index, kg/m2 25.39 ± 3.1225.78 ± 3.020.595
    Duration of pain, mo16.55 ± 5.4815.38 ± 5.410.370

    • Note: Qualitative data were expressed as number (%), and qualitative variables were expressed as the mean ± standard deviation.

  • Table 2

    Clinical presentation of patients.

    VariablesPosterolateral
    Approach (n = 31)    		Posterior Parasagital
    Approach (n = 40)    		 P Value
    Level of medial branch treated0.360
     C3-50 (0.0)2 (5.0)
     C4-618 (58.1)19 (47.5)
     C5-713 (41.9)19 (47.5)
    Duration of procedure, min54.68 ± 7.3944.13 ± 4.720.000a
    Complicationsb
     Neuritis4 (12.9)3 (7.5)0.449
     Numbness14 (45.2)12 (30.0)0.188
     Pruritus11 (35.5)16 (40.0)0.697
     Dysesthesia14 (45.2)21 (52.5)0.540

    • Note: Qualitative data were expressed as number (%), and qualitative variables were expressed as the mean ± SD.

    • aSignificant different between 2 groups where P < 0.05.

    • bSome patients presented with more than one complication.

  • Table 3

    Mean pain scores of patients at different time points.

    Time PointPosterolateral
    Approach (n = 31)    		Posterior Parasagital
    Approach (n = 40)    		 P Value
    Baseline NRS7.52 ± 1.217.43 ± 1.030.738
    NRS at 3 mo2.65a ± 1.082.77a ± 1.100.620
    NRS at 12 mo4.48b ± 1.414.55b ± 1.150.833

    • Note: Data expressed as the mean ± SD.

    • aSignificant different with baseline value where P < 0.001.

    • bSignificant different with baseline value where P < 0.05.

    • NRS, numerical rating scale.

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Single Entry Posterior Parasagittal Approach Radiofrequency Neurotomy of Cervical Medial Branch: A Feasible Alternative to Conventional Approaches in the Treatment of Cervical Facet Pain
Chee Kean Chen, Chung Chek Wong, Yian Young Teo, Vui Eng Phui
International Journal of Spine Surgery Dec 2021, 15 (6) 1192-1200; DOI: 10.14444/8151
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