Pain-Free Survival After Endoscopic Rhizotomy Versus Radiofrequency for Lumbar Facet Joint Pain: A Real-World Comparison Study

Background: Endoscopic rhizotomy (ER) of the medial branch has been recently developed for the treatment of lumbar facet joint pain (LFJP). However, there are no studies comparing the pain free duration after ER and radiofrequency (RF). Objectives: To evaluate the long-term outcomes for pain and physical function in patients who underwent ER versus RF for LFJP and compare their pain-free survival. Study Design: Open label, prospective, real-world study that includes patients treated with ER or RF at a single center between November 2017 and February 2020. Setting: The research took place within a single university-based neuro-spine center. Methods: Patients with a positive diagnostic medial branch block (>= 80% pain relief) were treated with ER or RF. Numeric rating scale (NRS), Oswestry Disability Index (ODI), and Global Impression of Change (GIoC) were obtained at the baseline, and at 6 months and 12 months postoperatively. The duration of pain-free time was recorded at every follow-up. The final follow-up was conducted in March 2021. Results: Of 55 patients with LFJP, 19 underwent ER, and 36 underwent RF. Both ER and RF groups showed significant decreases in NRS and ODI scores at 6 months and 12 months compared with baseline (P < 0.001). ER had significantly better efficacy than RF in NRS, ODI, and GIoC scores at 6 and 12 months (P < 0.05). The pain-free survival curves showed that the median pain-free duration was 20 months and 10 months in ER and RF, respectively. Limitation: Patients were not randomized to different groups, which may have led to bias. Conclusions: Both ER and RF can improve the pain and physical function in patients with LFJP. ER is associated with a longer operative duration and medical expenses; however, it provides more sustained efficacy than RF. The surgical choice should depend on the patients' specific conditions.