J Neurol Surg A Cent Eur Neurosurg 2020; 81(03): 238-242
DOI: 10.1055/s-0039-1698397
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Endoscopic 4-MHz Radiofrequency Treatment of Facet Joint Syndrome Is More Than Just Denervation: One Incision for Three Facets

Christian Woiciechowsky
1   Practice of Neurosurgery, Vivantes-Humboldt-Klinikum, Spine Clinic, Berlin, Germany
2   Department of Neurosurgery, Spine Center Berlin, Berlin, Germany
,
Leonie Mercedes Richter
2   Department of Neurosurgery, Spine Center Berlin, Berlin, Germany
3   Charité Medical Faculty Berlin, Berlin, Germany
› Author Affiliations
Further Information

Publication History

08 March 2019

23 May 2019

Publication Date:
14 January 2020 (online)

Abstract

Background and Study Aims Low back pain is well documented as an extremely common health problem. The most frequently used treatment is radiofrequency denervation for chronic low back pain. However, different clinical studies could only show a limited to no improvement regarding the decrease of pain intensity and duration of the effect. The main reasons for these limited effects seem to be due to the size of the lesion and difficulties in locating the exact placement of the cannula near the medial branch as well as or additional pathologies. Using an endoscope, it is possible to coagulate the facet joints and the medial branch under visual control and consider other pathologies such as extraspinal synovial cysts.

Patients In this retrospective study, we included 28 patients with low back pain, with a duration > 6 months and a 50% pain reduction on the numeric analog scale (NAS) after a diagnostic block. All patients received endoscopic facet joint denervation of three facets on the left and right side using only one incision on each side with an exploration of the surrounding tissue. Telephone interviews were conducted with all patients. The outcome was determined with Odom's criteria, percentage reduction NAS, subjective assessment of the patient, and duration of the effect.

Results According to Odom's criteria, 68% of the patients showed “acceptable” to “excellent” results and confirmed that denervation helped them manage their daily lives better. The average pain reduction in the responder group was 47% with an average duration of 7.8 months.

Conclusion In this retrospective study, we demonstrated the practicability and effectiveness of the endoscopic facet joint denervation procedure in the treatment of chronic low back pain using only one incision for three facets. Further studies should investigate if this procedure is more effective than percutaneous radiofrequency denervation.

 
  • References

  • 1 Schmidt CO, Raspe H, Pfingsten M. , et al. Back pain in the German adult population: prevalence, severity, and sociodemographic correlates in a multiregional survey. Spine 2007; 32 (18) 2005-2011
  • 2 Tymecka-Woszczerowicz A, Wrona W, Kowalski PM, Hermanowski T. Indirect costs of back pain—review. Polish Ann Med 2015; 22 (02) 143-148
  • 3 Wenig CM, Schmidt CO, Kohlmann T, Schweikert B. Costs of back pain in Germany. Eur J Pain 2009; 13 (03) 280-286
  • 4 Juch JNS, Maas ET, Ostelo RWJG. , et al. Effect of radiofrequency denervation on pain intensity among patients with chronic low back pain: The mint randomized clinical trials. JAMA 2017; 318 (01) 68-81
  • 5 van Wijk RMAW, Geurts JWM, Wynne HJ. , et al. Radiofrequency denervation of lumbar facet joints in the treatment of chronic low back pain: a randomized, double-blind, sham lesion-controlled trial. Clin J Pain 2005; 21 (04) 335-344
  • 6 Dreyfuss P, Halbrook B, Pauza K, Joshi A, McLarty J, Bogduk N. Efficacy and validity of radiofrequency neurotomy for chronic lumbar zygapophysial joint pain. Spine 2000; 25 (10) 1270-1277
  • 7 Hoy D, March L, Woolf A. , et al. The global burden of neck pain: estimates from the global burden of disease 2010 study. Ann Rheum Dis 2014; 73 (07) 1309-1315
  • 8 Poetscher AW, Gentil AF, Lenza M, Ferretti M. Radiofrequency denervation for facet joint low back pain: a systematic review. Spine 2014; 39 (14) E842-E849
  • 9 Cohen SP, Stojanovic MP, Crooks M. , et al. Lumbar zygapophysial (facet) joint radiofrequency denervation success as a function of pain relief during diagnostic medial branch blocks: a multicenter analysis. Spine J 2008; 8 (03) 498-504
  • 10 Lord SM, Barnsley L, Wallis BJ, McDonald GJ, Bogduk N. Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain. N Engl J Med 1996; 335 (23) 1721-1726
  • 11 Saito T, Steinke H, Miyaki T. , et al. Analysis of the posterior ramus of the lumbar spinal nerve: the structure of the posterior ramus of the spinal nerve. Anesthesiology 2013; 118 (01) 88-94
  • 12 Haufe SMW, Mork AR. Endoscopic facet debridement for the treatment of facet arthritic pain—a novel new technique. Int J Med Sci 2010; 7 (03) 120-123
  • 13 Jeong SY, Kim JS, Choi WS, Hur JW, Ryu KS. The effectiveness of endoscopic radiofrequency denervation of medial branch for treatment of chronic low back pain. J Korean Neurosurg Soc 2014; 56 (04) 338-343
  • 14 Walter SG, Schildberg F, Rommelspacher Y. Endoscopic sacrolumbar facet joint denervation in osteoarthritic and degenerated zygapophyseal joints. Arthrosc Tech 2018; 7 (12) e1275-e1279
  • 15 Li ZZ, Hou SX, Shang WL, Song KR, Wu WW. Evaluation of endoscopic dorsal ramus rhizotomy in managing facetogenic chronic low back pain. Clin Neurol Neurosurg 2014; 126: 11-17