Clinical Predictors of Success and Failure for Lumbar Facet Radiofrequency Denervation Steven P
ORIGINAL ARTICLE Clinical Predictors of Success and Failure for Lumbar Facet Radiofrequency Denervation Steven P. Cohen, MD,*w Robert W. Hurley, MD, PhD,* Paul J. Christo, MD,* James Winkley, MD,w Meraj M. Mohiuddin, MD,z and Milan P. Stojanovic, MDz with chronic low back complaints.1,2 Whereas previous Objective: To determine the clinical factors associated with the small, uncontrolled studies proposed a ‘‘lumbar facet success and failure of radiofrequency denervation of the lumbar syndrome’’ based on a scoring system composed of facet joints. historical and physical exam findings,3 larger, better designed studies failed to identify a set of clinical features Methods: Clinical data were garnered from 3 academic medical 4,5 centers on 192 patients with low back pain who underwent predictive of response to controlled blocks. It is now radiofrequency denervation after a positive response to diag- widely accepted that the only valid method to diagnose nostic blocks. Success was defined as Z50% pain relief lasting the lumbar facet joints as definitive pain generators is at least 6 months. Factors evaluated for their association with through the use of either diagnostic intra-articular z-joint injections or blockade of the medial branches and L5 outcome included duration of pain, opioid use, symptom 6 location, paraspinal tenderness, pain exacerbated by extension/ primary dorsal rami (MBB) that innervate the joints. rotation (ie, facet loading), MRI abnormalities, diabetes, Whereas these 2 techniques are widely believed to provide smoking, scoliosis, obesity, prior surgery and levels treated. comparable diagnostic utility, the evidence supporting this notion is based on only 2 randomized studies, neither Results: The only factor associated with a successful outcome of which used a crossover design or prescreened patients was paraspinal tenderness.
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