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 welltolerated. We suggest that a distal approach with an A-P view for facet radiofrequency thermocoagulation is a viable alternative to other approaches.

Lomber faset artropatili hastalarda lomber medial dalların perkütan radyofrekans termokoagülasyonu için distal yaklaşım: Retrospektif bir analiz

Amaç: Lomber faset (zigapofiziyal) artropati, kronik bel ağrısının yaygın bir nedenidir ve faset eklemlerinin perkütan radyofrekans denervasyonunun uzun vadeli iyileşme sağlayan etkili bir tedavi olduğu görülmektedir. İğneyi medial dallara paralel yerleştirmek için distal bir yaklaşım kullanan bir teknik son zamanlarda yaygın bir şekilde kullanılmaktadır. Bu çalışmada, distal bir yaklaşım ve A-P floroskopik görünümü içeren bir teknik araştırıldı. Gereç ve Yöntem: Faset eklem medial dallarında, RFTC (radyofrekans termokoagülasyon) uygulanan lomber faset sendromlu 164 hastanın klinik tabloları retrospektif olarak değerlendirildi. A-P görünümüyle distal bir yaklaşım kullanılarak gerçekleştirilen faset-eklem medial dallarının perkütan radyofrekans termokoagülasyonunun başarı oranı değerlendirildi. NRS (numerik rank scoru) ağrı skorları ve subjektif global değerlendirme skorunda cevaplar ölçüldü. Bulgular: Hastaların yanıtları, çok iyi 46 (%28.0), iyi 67 (%40.8), orta 21 (%12.8), kötü 30 (%18.2) olarak değerlendirildi. Ortalama ağrının sonlanma süresi 7.3 aydı. Çok iyi veya iyi yanıtlar veren 113 hastanın ortalama ağrı rahatlama süresi 10.2 aydı. Sonuç: Faset artropatisi için radyofrekans termokoagülasyon, iyi tolere edilen güvenli ve etkili bir tedavi seçeneğidir. Faset Radyofrekans termokoagülasyonu için A-P görüntüsü ile distal bir yaklaşımın diğer yaklaşımlara uygulanabilir bir alternatif olduğunu düşünüyoruz.

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