A Randomized Controlled Trial of Radiofrequency Denervation of the Ramus Communicans Nerve for Chronic Discogenic Low Back Pain

• Published in: The Clinical journal of pain Vol. 20; no. 1; pp. 55 - 60
• Main Authors: Oh, Wan Soo, Shim, Jae Chol
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins, Inc 01-01-2004; Lippincott Williams and Wilkins
• Subjects: Adult; Biological and medical sciences; Catheter Ablation - methods; Cordotomy - methods; Denervation - methods; Female; Fundamental and applied biological sciences. Psychology; Humans; Intervertebral Disc - innervation; Intervertebral Disc - surgery; Intervertebral Disc Displacement - complications; Intervertebral Disc Displacement - rehabilitation; Intervertebral Disc Displacement - surgery; Low Back Pain - diagnosis; Low Back Pain - etiology; Low Back Pain - rehabilitation; Low Back Pain - surgery; Lumbar Vertebrae - innervation; Lumbar Vertebrae - surgery; Male; Medical sciences; Neurology; Pain Measurement - methods; Patient Satisfaction - statistics & numerical data; Somesthesis and somesthetic pathways (proprioception, exteroception, nociception); interoception; electrolocation. Sensory receptors; Treatment Outcome; Vertebrates: nervous system and sense organs; Nociception; Nervous system diseases; percutaneous radiofrequency denervation; Lumbar spine; Low back pain; Diseases of the osteoarticular system; ramus communicans nerve; Spine disease; Radiofrequency; Percutaneous route; randomized controlled trial; Pain; Rachialgia; Denervation
• ISSN: 0749-8047; 1536-5409
• DOI: 10.1097/00002508-200401000-00011

OBJECTIVEThe objective of this study was to determine the efficacy of percutaneous radiofrequency (RF) thermocoagulation of the ramus communicans nerve in patients suffering from chronic discogenic low back pain.
METHODSForty-nine patients who suffered chronic discogenic low back pain at only 1 painful vertebral level, and whose pain continued after undergoing intradiscal electrothermal annuloplasty (IDET), were randomly assigned to 1 of 2 treatment groups. The lesion group (n = 26) received RF thermocoagulation of the ramus communicans nerve. Patients in the control group (n = 23) received an injection of lidocaine without radiofrequency. Visual analog scale (VAS) pain scores, analgesic requirements, SF-36 subscales, and the overall patient satisfaction with the procedure were tabulated.
RESULTSThe average follow-up period was 4 months. The patient-reported VAS pain scores were significantly lower (P < 0.05) in the lesion group. The scores of the RF lesion group improved by a mean increase of 11.3 points (P < 0.05) on the SF-36 bodily pain subscale, and by a mean increase of 12.4 points on the physical function subscale (P < 0.05). In a follow-up analysis within the RF lesion group, VAS pain scores improved by a mean reduction of 3.32 (P = 0.001). The scores improved by a mean increase of 14.5 points (P = 0.005) on the SF-36 bodily pain subscale and 15.2 points(P = 0.002) on the physical function subscale within the RF lesion group. One patient in the lesion group complained of mild lower limb weakness, but he completely recovered at postoperative 15 days without any serious problems.
DISCUSSIONIn patients with chronic discogenic low back pain, percutaneous RF denervation of the ramus communicans nerve should be considered as a treatment option.