Radiofrequency facet joint denervation efficiency based on the severity of spondylarthrosis and in osteoporotic vertebral compression fractures. A retrospective study

Abstract

Objectives: Radiofrequency denervation of the facet joints is performed via a well-established method. Its primary, direct indication is a positive response to a nerve block injection (MBB). Our study aimed to find other, effective but indirect indication signs through the retrospective analysis of our patients treated earlier.Patients and methods: In our institute between 1 January, 2008 and 31 December, 2017 facet joint denervation has been performed in more than 2000 cases, and we included 529 patients in our retrospective study. We had separate groups for vertebral compression fractures and for spondylarthrosis of different severity (Grade 1; 2-3; 4), thus we assessed the postoperative condition of these patients using Visual Analoge Scale (VAS). The efficacy of the intervention was examined in every groups separately according to symptoms and previous spine surgeries. Results: In view of our results, chronic lumbago and dorsalgia that are attributable to osteoporotic vertebral compression fracture are obvious indications if they do not respond to conservative therapy, as 76.8% of such patients remained asymptomatic for minimum 6 months (p = 0,000). Another indication is Grade 2 or 3 chronic spondylarthrosis without radicular involvement, since these groups reported a 51.4% success rate (asymptomatic for minimum 6 months) (p = 0,015). Long term pain relief is obviously impaired by the presence of radicular compression, as we were not able to decrease the pain of 97% of such patients. Our findings also suggest that the vast majority of those who have previously undergone spine surgery cannot benefit from the intervention. Conclusion:Based on this study, facet joint denervation can serve as an effective therapy supplement in a properly selected group of patients who do not respond to oral NSAIDs, exercise and physiotherapy. By this procedure we found we can reach long term benefit in the groups of osteoporotic vertebral fracture patients and patients with moderate spondylarthrosis. According to our results and the literature datas the properly patient selection for the indication of the RF ablation can be as effective as the controversial diagnostic nerve block injections.

The effect of additional facet joint block for analgesia in patients with thoracolumbar compression fracture undergoing percutaneous kyphoplasty surgery

“…However, some scholars have noted the phenomenon of residual back pain after percutaneous kyphoplasty. The facet joints have been recognized as a source of low back pain, and injection of local anesthetics (with or without steroids) to block innervation branches has been used to treat chronic low back pain caused by TCF [8–10] . However, it is controversial whether additional facet joint block can be used to relieve pain after percutaneous kyphoplasty.…”

Comparative Efficacy of Surgical Interventions for Osteoporotic Vertebral Compression Fractures: A Systematic Review and Network Meta-analysis

“…Notably, while VP targets pain arising from vertebral fractures, it demonstrates diminished efficacy in addressing pain attributed to residual injuries typically associated with posterior spinal trauma. For pain relief, targeting these nerves via facet joint injections has been proven efficacious [ 50 ]. A pioneering study by Kim et al [ 51 ] evaluated the impact of combining percutaneous VP with facet block across 612 vertebral levels of OVCF.…”

Vertebroplasty combined with facet joint block vs. vertebroplasty alone in relieving acute pain of osteoporotic vertebral compression fracture: a randomized controlled clinical trial

“…After vertebral compression fracture, the corresponding pathological changes appear in the posterior column of the spine, which stimulates the dorsal nerve branch and causes pain [17,18]. The literature suggests that facet joint block, which can block the posterior medial branch of the spinal nerve, is effective in relieving the acute pain of vertebral compression fractures [19]. Compared with PVP, FB requires less expend and shows fewer complications, such as vein embolism and neural injury.…”