Neurotomy of the cervical, thoracic, lumbar, and sacroiliac joints were uniformly successful with 72% recipients obtaining an average of 86% reduction in pain for a period of 12 months.

Objectives (1) To determine the prevalence of cervical zygapophyseal joint pain in a specialist clinical setting; (2) to review the number of diagnostic blocks needed to identify the segmental level of the symptomatic joints; and (3) to determine the distribution of segmental levels of cervical zygapophyseal joint pain in a clinical setting. Design and setting Retrospective audit of patients of three independent rehabilitation medicine specialists who had undergone cervical zygapophyseal joint blocks in hospital outpatient clinics and private rooms. Patients 97 patients aged 18–82 years with chronic neck pain (with or without headache) of more than six months' duration refractory to conservative therapies. Intervention Diagnostic fluoroscopic cervical third occipital and medial branch blocks of zygapophyseal joints. Diagnosis required confirmation by a repeat procedure. Results 35 of 97 patients (36%) had a confirmed symptomatic cervical zygapophyseal joint (95% CI, 27%–45%). The symptomatic segmental level was found at the first attempt by reference to a standard pain diagram in 83% of cases (29 of 35). The most common symptomatic levels were C3‐4 (11/35; 31%) and C5‐6 (10/35; 29%). Conclusion The prevalence of cervical zygapophyseal joint pain estimated in this clinical study is lower than that found in previous research setting studies, but our requirement for confirmation by a repeat block (which many patients declined) makes our estimate conservative; it is likely that the true prevalence is higher. Zygapophyseal joints are clearly a common source of pain in patients presenting with chronic neck pain, with or without headache. Cervical zygapophyseal joint pain is readily diagnosable, enabling patients to seek further, targeted treatment.

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Background There are many physical, pharmacological, and interventional therapies aimed at alleviating sacroiliac ligament/joint complex pain, including thermal neurotomy. Sacroiliac joint (SIJ) innervation, as opposed to posterior sacroiliac ligament complex innervation, remains uncertain; thus lateral branch thermal neurotomy to alleviate sacroiliac joint pain remains controversial. Objective This study aimed to compare the success rates of two lateral branch neurotomy techniques, large continuous-lesion multi-electrode radiofrequency neurotomy (RFN; Simplicity, Neurotherm Inc.) and small-lesion monopolar periforaminal, to relieve pain from sacroiliac joints, as well as whether these would alter physical and psychological health. Design Retrospective clinical audit of prospectively gathered consecutive data. Setting A private community-based multidisciplinary pain clinic. Subjects Referred from primary care environments. Methods Of 96 consecutive thermal neurotomies with baseline data completed, follow-up data were found in 73 patients during the period 2011–2017. After diagnosis by dual-positive fluoroscopic intra-articular injections, 41 patients underwent 47 monopolar periforaminal neurotomies, and 32 underwent 49 large continuous-lesion multi-electrode RFNs, with >12-month follow-up. The primary outcome was 50–100% relief of pain for more than six months. Results are presented as success rates. Secondary outcomes were Functional Rating Index Depression Anxiety and Stress Scale and Patient Specific Functional Scale. Results Follow-up data were available for 80 (83%) of the 96 procedures. Success occurred in 69% of all procedures (39% complete >75% relief and 30% good 50–75% relief). Success was 57% with worst-case analysis. Success rates were 71% in the large continuous-lesion multi-electrode RFN group and 65% in the periforaminal group, with overlapping confidence intervals. Significant improvements also occurred in the secondary measures. Conclusions Thermal neurotomy demonstrated a 69% success rate in reduction of sacroiliac ligament/joint complex pain for more than six months equally by large continuous-lesion multi-electrode RFN and periforaminal monopolar techniques, with attendant improvement in physical and psychological function.

Objective Thoracic spinal pain is common, and patients with this type of pain have limited therapeutic options. The cohort in this study received diagnostic intra-articular zygapophysial joint injections leading to thermal neurotomy to the medial branch nerves to demonstrate improved pain as well as physical and psychological function. Design A consecutive cohort from 2012 to 2018 with retrospective analysis of prospectively gathered data. Setting A private multidisciplinary pain clinic with referrals from primary care. Results Forty-six complete data sets from 39 patients were found using a pre-procedure and 3-month post-procedure questionnaire. Further follow-up results were found for the dual primary outcomes of duration of ≥50% relief using a numeric rating scale (NRS) for the entire group. The group was then divided into three subgroups of T1/2–T3/4, T4/5–T8/9, and T9/10–T12/L1. Success rates of 63% for ≥3 months of ≥50% relief and 46% for ≥6 months of ≥50% relief were found, for an average duration of 7.8 months. Group mean change in the NRS was 6.7, decreasing to 4.3 (P<0.0001). For the first time, there are data showing that the three groups of T1/2–T3/4, T4/5–T8/9, and T9/10–T12/L1 responded equally. Secondary outcomes of physical and psychological function using the Functional Rating Index (FRI) and the Depression Anxiety Stress Scale (DASS) all showed significant improvements with small to moderate effect sizes and with all achieving >36% improvement in scores. Conclusion This cohort demonstrates that there is a pragmatic diagnostic and therapeutic option available for patients with thoracic zygapophysial joint pain that can achieve 50–100% of pain relief in 63% of patients with improved physical and psychological function.