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Comparison of alcohol ablation with repeated thermal radiofrequency ablation in medial branch neurotomy for the treatment of recurrent thoracolumbar facet joint pain

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Abstract

Purpose

Chemical denervation is not recommended as part of the routine care of chronic non-cancer pain. Physicians face a dilemma when it comes to repeated interventions in cases of recurrent thoracolumbar facet joint pain after successful thermal radiofrequency ablation (RFA) in medial branch neurotomy. This study was performed to compare the effects of alcohol ablation (AA) with thermal RFA in patients with recurrent thoracolumbar facet joint pain after thermal RFA treatment.

Methods

Forty patients with recurrent thoracolumbar facet joint pain after successful thermal RFA defined as a numeric rating scale (NRS) score of ≥7 or a revised Oswestry disability index (ODI) of ≥22 % were randomly allocated to two groups receiving either the same repeated RFA (n = 20) or AA (n = 20). The recurrence rate was assessed with NRS and ODI during the next 24 months, and adverse events in each group were recorded.

Results

During the 24-month follow-up after RFA and AA, one and 17 patients, respectively, were without recurring thoracolumbar facet joint pain. The median effective periods in the RFA and AA groups were 10.7 (range 5.4–24) and 24 (range 16.8–24) months, respectively (p < 0.000). No significant complications were observed with the exception of injection site pain, which occurred in both groups.

Conclusion

In our patient cohort, alcohol ablation in medial branch neurotomy provided a longer period of pain relief and better quality of life than repeated radiofrequency medial branch neurotomy in the treatment of recurrent thoracolumbar facet joint pain syndrome after successful thermal RFA without significant complications during the 24-month follow-up.

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References

  1. Soloman M, Mekhail MN, Mekhail N. Radiofrequency treatment in chronic pain. Expert Rev Neurother. 2010;10:469–74.

    Article  PubMed  Google Scholar 

  2. Schofferman J, Kine G. Effectiveness of repeated radiofrequency neurotomy for lumbar facet pain. Spine. 2004;29:2471–3.

    Article  PubMed  Google Scholar 

  3. Govind J, Bogduk N. Neurolytic blockade for noncancer pain. In: Fishman SM, Ballantyne JC, Rathmell JP, editors. 4th ed. Bonica’s management of pain. Philadelphia: Wolters Kluwer Lippincott William & Wilkins; 2010. p. 1467–85.

  4. American Society of Anesthesiologists Task Force on Chronic Pain Management; American Society of Regional Anesthesia and Pain Medicine. Practice guidelines for chronic pain management: an updated report by the American Society of Anesthesiologists Task Force on Chronic Pain Management and the American Society of Regional Anesthesia and Pain Medicine. Anesthesiology. 2010;112:810–33.

    Google Scholar 

  5. Hudson-Cook N, Tomes-Nicholson K, Breen A. A revised Oswestry disability questionnaire. In: Roland M, Jenner JR, editors. Back pain: new approaches to rehabilitation and education. Manchester: Manchester University Press; 1989. p. 187–204.

    Google Scholar 

  6. Manchikanti L, Singh V, Falco FJ, Cash KA, Pampati V. Effectiveness of thoracic medial branch blocks in managing chronic pain: a preliminary report of a randomized, double-blind controlled trial. Pain Phys. 2008;11:491–504.

    Google Scholar 

  7. Manchikanti L, Datta S, Gupta S, Munglani R, Bryce DA, Ward SP, Benyamin RM, Sharma ML, Helm S 2nd, Fellows B, Hirsch JA. A critical review of the American Pain Society Clinical practice guidelines for interventional techniques: part 2 Therapeutic interventions. Pain Phys. 2010;13:E215–64.

    Google Scholar 

  8. Koyyalagunta D, Burton AW. The role of chemical neurolysis in cancer pain. Curr Pain Headache Rep. 2010;14:261–7.

    Article  PubMed  Google Scholar 

  9. Vatansever D, Tekin I, Tuglu I, Erbuyun K, Ok G. A comparison of the neuroablative effects of conventional and pulsed radiofrequency techniques. Clin J Pain. 2008;24:717–24.

    Article  PubMed  Google Scholar 

  10. Silvers HR. Lumbar percutaneous facet rhizotomy. Spine. 1990;15:36–40.

    Article  PubMed  CAS  Google Scholar 

  11. Shealy CN. Percutaneous radiofrequency denervation of spinal facets. Treatment for chronic back pain and sciatica. J Neurosurg. 1975;43:448–51.

    Article  PubMed  CAS  Google Scholar 

  12. Son JH, Kim SD, Kim SH, Lim DJ, Park JY. The efficacy of repeated radiofrequency medial branch neurotomy for lumbar facet syndrome. J Korean Neurosurg Soc. 2010;48:240–3.

    Article  PubMed  Google Scholar 

  13. Navarro X. Chapter 27: neural plasticity after nerve injury and regeneration. Int Rev Neurobiol. 2009;87:483–505.

    Article  PubMed  Google Scholar 

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Correspondence to Kyung-Hoon Kim.

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Joo, YC., Park, JY. & Kim, KH. Comparison of alcohol ablation with repeated thermal radiofrequency ablation in medial branch neurotomy for the treatment of recurrent thoracolumbar facet joint pain. J Anesth 27, 390–395 (2013). https://doi.org/10.1007/s00540-012-1525-0

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  • DOI: https://doi.org/10.1007/s00540-012-1525-0

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