Best practice in radiofrequency denervation of the lumbar facet joints: a consensus technique

Eldabe, Sam; Tariq, Anisah; Nath, Sherdil; Gulve, Ashish; Antrobus, Hugh; Baloch, Mohjir; Buczkowski, Piotr; Collighan, Neil; Fernandez, Tacson; Fritz, Ann-Katrin; Humble, Stephen R.; Huygen, Frank; Krishnan, Murali; Mehta, Vivek; Mishra, Sailesh Kumar; Muthukrishnan, Sundar; Snidvongs, Saowarat; Tamosauskas, Rokas; Underwood, Martin

doi:10.1177/2049463719840053

Cited by 14 publications

(17 citation statements)

References 15 publications

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“…On the other hand, placing the electrodes perpendicular to the target nerve could theoretically miss it, since radiofrequency electrodes do not effectively coagulate tissues distal to their tip (they coagulate in a radial direction around the exposed tip, perpendicular to the long axis of the electrode) 41 . The second hypothesis, although defended by the SIS 11 and studied in some articles, 42–44 has not been comparatively demonstrated in a prospective clinical study with stringent criteria for selecting patients. The primary outcome of the present study was to determine if there were any differences in pain scores between the 2 techniques.…”

Section: Discussionmentioning

confidence: 99%

Randomized Pragmatic Pilot Trial Comparing Perpendicular Thin Electrode Versus Parallel Thick Electrode Approaches for Lumbar Medial Branch Neurotomy in Facetogenic Low Back Pain

Ares

Gilsanz

2020

Pain Practice

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Objectives: Although there are different ways of performing medial branch neurotomy on facetogenic low back pain, few studies have compared clinical outcomes of a parallel technique over the medial branch vs. a perpendicular technique. We investigated differences in pain outcome with both techniques. Design: This was a prospective, pilot, randomized, pragmatic trial (double blinded in the diagnostic phase). Setting: A comparative pilot trial was conducted at an academic pain center. Methods: Patients who did not respond to conservative medications and had severe lumbar pain for more than 3 months (VAS score ≥ 65) were included. A double diagnostic block with local anesthetic and placebo was performed, double blinded. Patients who had 80% relief from the local anesthetic and no substantial relief from placebo were randomized to undergo medial branch neurotomy under fluoroscopy, placing an electrode parallel or perpendicular to the medial branch. The primary outcome was differences in the VAS score at 1, 3, and 6 months. The secondary outcomes were Oswestry Disability Index score, Roland Morris Questionnaire score, and other functional Likert scale scores. Results: Forty-three consecutive patients were randomized to parallel (n = 20) or perpendicular (n = 23) neurotomy. There were no significant differences in VAS, Oswestry Disability Index, or Roland Morris Questionnaire scores at 1, 3, or 6 months between groups. Statistically significant differences were found in the categorical analysis at 6 months in the evolution of pain, Oswestry Disability Index score, Roland Morris Questionnaire score, and some Likert scale scores in favor of the parallel group. Conclusions: There were differences at 6 months in the categorical analysis of the evolution of pain, Oswestry Disability Index score, Roland Morris Questionnaire score, and some functional Likert scale scores, all in favor of the parallel group. &

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Section: Discussionmentioning

confidence: 99%

Randomized Pragmatic Pilot Trial Comparing Perpendicular Thin Electrode Versus Parallel Thick Electrode Approaches for Lumbar Medial Branch Neurotomy in Facetogenic Low Back Pain

Ares

Gilsanz

2020

Pain Practice

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“…Fourteen clinicians responded to the survey (82%). Seven clinicians disagreed with one or more aspects of the United Kingdom consensus guidelines published by Eldabe et al 20 Aspects of disagreement included the following: 0.5 mL of levo-bupivacaine 5 mg/mL as the preferred solution for MBB (n = 1); the need for intravenous (IV) access to be routinely established (n = 1); use of an 18G RF needle (n = 1); use of a curved needle (n = 2); no sensory testing (n = 1) and lesioning at 80°C for 120 seconds (n = 3). Other issues raised included the lack of a definition for a positive response to MBB (n = 1) and lack of clarity on the motor testing (n = 1).…”

Section: Surveymentioning

confidence: 99%

“…Therefore, the international guidance from Cohen et al was included in the survey but not the workshop. Paper copies of two of the three documents previously circulated were distributed to attendees: the NLBRPP recommendations for the selection of patients for RFD 4 and the recommendations given by Eldabe et al 20 on the RFD technique. In small groups, the attendees discussed the two guidance documents and decided whether all the components of the two documents should be mandatory or optional.…”

Section: Workhopmentioning

confidence: 99%

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Radiofrequency denervation of the lumbar facet joints: guidelines for the RADICAL randomised controlled trial

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Reeves

Ahmad

et al. 2020

British Journal of Pain

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Background and aim: The RADICAL trial has been funded by the National Institute for Health Research (NIHR) to evaluate the clinical and cost-effectiveness of radiofrequency denervation (RFD) for low back pain. Recommendations have been published which aim to standardise selection of patients and RFD technique. However, it is important to ensure these recommendations are acceptable to clinicians within the context of the trial. The aim of this work was to develop standardised criteria for the trial entry and RFD technique for implementation within the RADICAL trial. Methods: Fourteen pain clinicians completed a survey, which involved reviewing the current recommendations and indicating whether they disagreed with any of the recommendations and if so why. Responses were collated and presented at a half-day workshop with 14 attendees. During the workshop, the National Low Back and Radicular Pain Pathway (NLBRPP) guidelines for patient selection and an article by Eldabe and colleagues presenting recommendations on the RFD technique were reviewed. Attendees discussed whether each component of the recommendations should be mandatory, mandatory with alteration or clarification or optional within the RADICAL trial. Results: Attendees agreed during the workshop that 5 of the 10 criteria for patient selection described in the NLBRPP should be mandatory within the RADICAL trial. Three were agreed as mandatory criteria but required further clarification, one of which involved defining a positive response to a diagnostic medial branch block as ⩾60% pain relief. Two criteria had optional components. After reviewing the recommendations on the RFD technique from Eldabe and colleagues, seven components were agreed as mandatory, three were mandatory with alterations and three were optional. Conclusion: When evaluating complex interventions, such as RFD, it is important to ensure agreement and clarity on the clinical protocol, so that the intervention can be reproduced, if found to be effective.

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“…This issue of the British Journal of Pain demonstrates the diversity in pain research and contains papers that will be of interest to practitioners from many disciplines covering a diverse range of topics from best practice in radiofrequency denervation procedures, 2 the cerebral effects of paracetamol, 3 cognitive analytical therapy, 4 to the importance of communication in postsurgical pain. 5…”

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confidence: 99%

Pain is complex

2020

British Journal of Pain

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Best practice in radiofrequency denervation of the lumbar facet joints: a consensus technique

Cited by 14 publications

References 15 publications

Randomized Pragmatic Pilot Trial Comparing Perpendicular Thin Electrode Versus Parallel Thick Electrode Approaches for Lumbar Medial Branch Neurotomy in Facetogenic Low Back Pain

Randomized Pragmatic Pilot Trial Comparing Perpendicular Thin Electrode Versus Parallel Thick Electrode Approaches for Lumbar Medial Branch Neurotomy in Facetogenic Low Back Pain

Radiofrequency denervation of the lumbar facet joints: guidelines for the RADICAL randomised controlled trial

Pain is complex

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