Endoscopic rhizotomy for chronic lumbar zygapophysial joint pain

• Published in: Journal of orthopaedic surgery and research Vol. 15; no. 1; p. 4
• Main Authors: Xue, Yuntao, Ding, Tao, Wang, Dajie, Zhao, Jianli, Yang, Huilin, Gu, Xiaofeng, Feng, Dehong, Zhang, Yafeng, Liu, Hao, Tang, Fenglin, Wang, Wanyi, Lu, Miao, Wu, Chao
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 03-01-2020; BioMed Central; BMC
• Subjects: Ablation (Surgery); Analgesia; Anesthesia; Arthralgia; Arthritis; Back pain; Body mass index; Bupivacaine; Chronic low back pain; Denervation; Endoscope; Endoscopy; Low back pain; Lumbar facet syndrome; Lumbar medial branch nerves; Medial branches of the dorsal rami; Medical research; Nerves; Orthopedics; Pain management; Postoperative complications; Retirement benefits; Surgery; Time; Lumbar medial branch nerves; Chronic low back pain; Lumbar facet syndrome; Medial branches of the dorsal rami; Endoscope
• ISSN: 1749-799X; 1749-799X
• DOI: 10.1186/s13018-019-1533-y

Chronic lumbar zygapophysial joint pain is a common cause of chronic low back pain. Percutaneous radiofrequency ablation (RFA) is one of the effective management options; however, the results from the traditional RFA need to be improved in certain cases. The aim of this study is to investigate the effect of percutaneous radiofrequency ablation under endoscopic guidance (ERFA) for chronic low back pain secondary to facet joint arthritis.
This is a prospective study enrolled 60 patients. The cases were randomized into two groups: 30 patients in the control group underwent traditional percutaneous radiofrequency ablation, others underwent ERFA. The lumbar visual analog scale (VAS), MacNab score, and postoperative complications were used to evaluate the outcomes. All outcome assessments were performed at postoperative 1 day, 1 month, 3 months, 6 months, and 12 months.
There was no difference between the two groups in preoperative VAS (P > 0.05). VAS scores, except the postoperative first day, in all other postoperative time points were significantly lower than preoperative values each in both groups (P < 0.05). There was no significant difference between the two groups in VAS at 1 day, 1 month, and 3 months after surgery (P > 0.05). However, the EFRA demonstrated significant benefits at the time points of 3 months and 6 months (P > 0.05). The MacNab scores of 1-year follow-up in the ERFA group were higher than that in the control group (P < 0.05). The incidence of complications in the ERFA group was significantly less than that in the control group (P < 0.05).
ERFA may achieve more accurate and definite denervation on the nerves, which leads to longer lasting pain relief.