From the Guidelines
Radiofrequency neurotomy of the left L4-L5 and L5-S1 facet joints is a recommended treatment for patients with chronic low back pain originating from these specific facet joints, as it can provide significant pain relief for 6-18 months or longer, as supported by the study published in the British Journal of Anaesthesia 1.
Procedure Overview
The procedure involves using radiofrequency energy to heat and deactivate the medial branch nerves that supply sensation to these joints, thereby interrupting pain signals.
- Patients typically undergo diagnostic medial branch blocks first to confirm that these joints are the pain source before proceeding to neurotomy.
- The procedure is performed under local anesthesia with sedation, and takes about 30-60 minutes.
- Recovery is relatively quick, with most patients returning home the same day.
Post-Procedure Care
- Patients should avoid strenuous activities for about two weeks post-procedure.
- Temporary soreness at the injection sites can be managed with ice packs and over-the-counter pain medications like acetaminophen or ibuprofen (400-600mg every 6 hours as needed).
Mechanism of Action
This procedure works by creating a controlled lesion on the nerve, preventing pain transmission while allowing the nerve to eventually regenerate, which explains why the pain relief is significant but not permanent, as noted in the guidelines published in the Annals of Internal Medicine 1.
From the Research
Radiofrequency Neurotomy for Lumbar Facet Joint Pain
- Radiofrequency neurotomy (RFN) is a treatment method for facet joint pain, which involves the use of heat to damage the nerves that carry pain signals from the facet joints 2.
- The procedure has been shown to be effective in providing relief from chronic low back pain, with studies demonstrating significant improvements in pain scores and quality of life [(3,4,5,6)].
- However, as with any medical procedure, there are potential risks and complications associated with RFN, including the possibility of irreversible injury to non-target nerves 2.
Efficacy of Radiofrequency Neurotomy
- Studies have consistently shown that RFN is an effective treatment for lumbar facet joint pain, with success rates ranging from 85% to 100% [(3,5)].
- The duration of relief from pain has been reported to be around 9-10 months, with some studies showing that repeated RFN procedures can provide consistent relief [(3,5)].
- A meta-analysis of studies on RFN for chronic lumbar and sacroiliac joint pain found that RFN was associated with significant improvements in pain scores, quality of life, and functional ability 6.
Comparison with Other Treatments
- A study comparing RFN with lumbar facet joint nerve blocks found that both treatments provided significant pain relief, with similar outcomes and cost utility 4.
- Another study found that RFN was more effective than conservative non-surgical approaches in improving pain scores and quality of life 6.