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Repeat Percutaneous Radiofrequency Facet Joint Denervation for Chronic Back Pain: A Prospective Study

ABSTRACT Objective: To investigate whether repeat lumbar percutaneous radiofrequency facet joint denervation [RFJD] is an efficacious ongoing treatment for chronic low back pain [LBP] using the Low Back Outcome Score [LBOS] and subjective measures of patient satisfaction. Methods: A prospective open-label, single intervention study was carried out on a consecutive series of patients undergoing repeat lumbar RFJD performed by a single operator in 2007. Patients with an initially successful RFJD procedure were selected for the study excluding patients with greater than four procedures in total. Lumbar medial branch neurotomy was conducted using a 20-gauge silicone-coated probe inserted under fluoroscopic control and neuroleptic intravenous sedation with radiofrequency thermal energy applied for 90 seconds per joint at a maximum probe tip temperature of 90°C. The patients completed a LBOS questionnaire before and 12 months following the repeat RFJD procedure. They were also asked about their satisfaction with and the duration of pain relief related to their repeat procedure. Results: Sixty-two patients completed the study. At 12-month follow-up, clinical outcomes were improved with the proportion of patients with poor rating according to LBOS decreasing from 69.4 percent pre-procedure to 41.9 percent after repeat RFJD [P < 0.01]. Overall, 69.3 percent of patients were satisfied with the procedure with a median average duration of eight to nine months for pain relief. There were no complications in this series. Conclusion: Repeat lumbar RFJD, in this cohort of appropriately selected patients, achieved a high level of satisfaction and improved LBOS score, and may be a valid option for ongoing treatment for patients with chronic LBP. It would appear that a blinded, randomized, sham treatment-controlled clinical trial would be warranted.