Distal approach for percutaneous radiofrequency thermocoagulation of lumbar medial branches in patients with lumbar facet arthropathy: A retrospective analysis

Objectives: Lumbar facet (zygapophysial) arthropathy is a common cause of chronic lower back pain, and percutaneous radiofrequency denervation of the facet joints appears to be an effective treatment that yields long-term improvement. A technique utilising a distal approach to place the needle parallel to the medial branch has recently come into common use. In the present study, a technique incorporating a distal approach and an A-P fluoroscopic view was investigated. Methods: In this study, clinical charts of 164 patients with lumbar facet syndrome who had undergone RFTC (radiofrequency thermocoagulation) of facet-joint medial branches were retrospectively evaluated. The success rate of percutaneous radiofrequency thermocoagulation of facet-joint medial branches performed utilising a distal approach with an A-P view was evaluated. NRS (numeric rank score) pain scores and subjective patient-reported global responses were measured. Results: Of the patients, responses were rated as excellent by 46 (28.0%), good by 67 (40.8%), fair by 21 (12.8%) and poor by 30 (18.2%).The median duration of pain relief was 7.3 months. In the 113 patients who reported excellent or good responses, the median duration of pain relief was 10.2 months. Conclusion: Radiofrequency thermocoagulation for facet arthropathy is a safe and effective treatment option that is well-tolerated. We suggest that a distal approach with an A-P view for facet radiofrequency thermocoagulation is a viable alternative to other approaches.