Introduction: Low back pain (LBP) is one of the most common health problems, representing the second most frequent reason for primary care consultation and a frequent motive to neurosurgical referral. Lifetime prevalence of LBP ranges from 60 to 90%.
Facet joints can be a source of chronic and persistent spinal pain and have been implicated in 15%–40% cases of axial LBP. Lumbar facet joints are responsible for local and referred pain to adjacent areas. Sacroiliac joint pain is also a challenging condition accounting for approximately 20% of cases of chronic LBP.
We aim to evaluate the efficacy over time of percutaneous radiofrequency neurotomy for lumbar facet syndrome and sacroiliac joint pain.
Methods: Retrospective study of all consecutive cases of continuous percutaneous medial branch radiofrequency for lumbar facet syndrome and sacroiliac joint pain, carried out between November 2009 and December 2013, in one center, by a single neurosurgeon. Outcome was assessed using the numerical rating scale (NRS), at baseline and at 1, 3, 6, 12, 18 and 24 months after radiofrequency. Statistical analysis was calculated with Prism6 v.6.0 for Mac OS-X.
Results: Of the 52 patients evaluated 40 were female and 12 were male, with a mean age of 54±14 years. Rate of efficacy (defined as =50% pain relief, using the NRS) was 76.9% at 1-month, 71.2 % at 3-months, 61.0% at 6-months, 54.6% at 12-months, 49.1% at 18-months and 43.0 % at 24 months. Ninety-two percent of consider the treatment was successful and 88.5% would repeat it, if needed. There was no difference in efficacy between patients treated for facet pain or sacroiliac joint pain (p=0.67).
Conclusions: Radiofrequency neurotomy was usefull for treatment of lumbar facet syndrome and sacroiliac joint pain. Despite of gradual loss of efficacy, at 2-years 40% of patients maintain a 50% reduction of pain intensity. Therefore this procedure could be used for treatment of carefully selected patients with chronic LBP.
Patient Care: Reinforces evidence that in careful selected patients percutaneous neurotomy represents a valid option for lumbar facet syndrome and sacroiliac joint pain treatment, giving more options when treating such a burden condition as low back pain is.
Learning Objectives: Access the efficacy of percutaneous neurotomy for lumbar facet syndrome and sacroiliac joint pain.