This study demonstrated clinically meaningful improvements in pain and physical function up to six months following cRFA. A prognostic genicular nerve block using a local anesthetic volume of 1 mL at each injection site and a threshold of ≥ 50% pain relief for subsequent cRFA eligibility did not improve the rate of treatment success.

The subjects reported low levels of pain, moderate levels of life satisfaction, normal levels of sleepiness, low-to-moderate levels of fatigue, infrequent spasms at mild-to-moderate severity, and high levels of satisfaction. The efficacy and favorable adverse effect profile of ITB therapy was sustained in this cohort of subjects with more than a decade of treatment.

Objective Determine the effectiveness of intraosseous basivertebral nerve radiofrequency neurotomy for the treatment of chronic low back pain with type 1 or 2 Modic changes. Design Systematic review. Population Persons aged >18 years with chronic low back pain with type 1 or 2 Modic changes. Intervention Intraosseous basivertebral nerve radiofrequency neurotomy Comparison Sham, placebo procedure, active standard care treatment, or none. Outcomes The primary outcome of interest was the proportion of individuals with ≥50% pain reduction. Secondary outcomes included ≥10-point improvement in function as measured by Oswestry Disability Index as well as ≥2-point reduction in pain score on the Visual Analog Scale or Numeric Rating Scale, and decreased use of pain medication. Methods Three reviewers independently assessed publications before 5/15/2020 in MEDLINE and Embase and the quality of evidence was evaluated using the Grades of Recommendation, Assessment, Development, and Evaluation framework. Results Of the 725 publications screened, seven publications with 321 participants were ultimately included. The reported three-month success rate for ≥50% pain reduction ranged from 45-63%. Rates of functional improvement (≥10-point Oswestry Disability Index improvement threshold) ranged from 75-93%. For comparison to sham treatment, the relative risk of treatment success defined by ≥50% pain reduction and ≥10-point Oswestry Disability Index improvement was 1.25 (95% Confidence Interval: 0.88 - 1.77) and 1.38 (95% Confidence Interval: 1.10 - 1.73), respectively. For comparison to continued standard care treatment the relative risk of treatment success defined by ≥50% pain reduction and ≥10-point Oswestry Disability Index improvement was 4.16 (95% Confidence Interval: 2.12 - 8.14) and 2.32 (95% Confidence Interval: 1.52 - 3.55), respectively. Conclusion There is moderate-quality evidence that suggests this procedure is effective in reducing pain and disability in patients with chronic low back pain who are selected based on type 1 or 2 Modic changes, among other inclusion and exclusion criteria used in the published literature to date. Success of the procedure appears to be dependent on effective targeting of the BVN. Non-industry funded high-quality, large prospective studies are needed to confirm these findings.

This case series suggests that TFESI can provide modest short-term symptom relief of lumbosacral radicular pain and improvement in disability caused by SEL. Further study of non-operative management of SEL is warranted, given the high risk associated with surgery in this population.