Optimal Temperature for Radiofrequency Ablation of Lumbar Medial Branches for Treatment of Facet-Mediated Back Pain

Shrif Costandi; Mauricio Garcia-Jacques; Teresa Dews; Michael Kot; Kevin Wong; Gerges Azer; Jasmyn Atalla; Michael Looka; Elie Nasr; Nagy Mekhail

doi:10.1111/papr.12346

Optimal Temperature for Radiofrequency Ablation of Lumbar Medial Branches for Treatment of Facet-Mediated Back Pain

Pain Pract. 2016 Nov;16(8):961-968. doi: 10.1111/papr.12346. Epub 2015 Sep 15.

Authors

Shrif Costandi^{1

2}, Mauricio Garcia-Jacques¹, Teresa Dews¹, Michael Kot³, Kevin Wong³, Gerges Azer², Jasmyn Atalla⁴, Michael Looka⁵, Elie Nasr⁶, Nagy Mekhail^{1

2}

Affiliations

¹ Department of Pain Management, Cleveland Clinic, Cleveland, Ohio, U.S.A.
² Evidence Based Pain Medicine Research, Cleveland Clinic, Cleveland, Ohio, U.S.A.
³ Department of General Anesthesiology, Cleveland Clinic, Cleveland, Ohio, U.S.A.
⁴ Ohio State University, Columbus, Ohio, U.S.A.
⁵ Oakland University, Rochester, Michigan, U.S.A.
⁶ Case Western Reserve University, Cleveland, Ohio, U.S.A.

PMID: 26369502
DOI: 10.1111/papr.12346

Abstract

Background: Radiofrequency ablation (RFA) of the medial branch nerves that innervate the facet joints is a well-established treatment modality; however, studies to determine the optimal radiofrequency ablation temperature are lacking. A wide range (70 to 90°C) has been used. This study aimed to compare outcomes with two set temperatures for the lumbar facet medial branch ablation, 90 and 80°C.

Methods: This retrospective study compared the degree of patient self-reported functional improvement relief, postoperative opioid dose changes, as well as duration among lumbar facet medial branch (RFA) patients who had the procedures performed at 80 or 90°C.

Results: Patients who underwent the procedure at 90°C had 3.1 (95% CI 1.7, 6.5) times the odds (P = 0.0004) of reporting functional improvement of at least 50% when compared to those who underwent neurotomy at 80°C. For self-reported functional improvement greater or equal to 75%, the results were sustained with an odds ratio of 2.8 (95% CI 1.2, 5.7) favoring those with 90°C temperature neurotomy (P = 0.002).

Conclusion: There seems to be significant functional improvement associated with temp of 90°C compared to 80°C, with no added risk of complications. Randomized controlled studies are warranted.

Keywords: facet denervation; facet-mediated back pain; low back pain; medial branch; neurotomy; optimal temperature; outcomes; radiofrequency ablation.