• Kenneth B Chapman, Frank Schirripa, Thomas Oud, Pauline S Groenen, Ryan R Ramsook, and Noud van Helmond.
• Spine & Pain Institute of New York, New York City, New York; Department of Anesthesiology, New York University Langone Medical Center, New York City, New York.
• Pain Physician. 2020 Sep 1; 23 (5): E507-E516.

BackgroundRadiofrequency ablation (RFA) of the medial branches of the dorsal rami has been reported to relieve facet joint-related back pain for 6 months to 1 year in 60% of patients. Although providing benefit in a significant proportion of patients, there remains a group of patients who do not experience any pain relief from RFA or experience only benefit from the ablation for a short period. Failure of RFA has been attributed to technical failure of coagulating the nerve or coagulation of a minimal section of the nerve, allowing for early reinnervation. Increasing the success rate and duration of relief may require techniques that increase the likelihood of successful nerve ablation over a relevant distance by maximizing lesion size.ObjectivesThe aim of this technical note is to detail a modification to the current commonly used lumbar medial branch radiofrequency (RF) denervation approach to increase lesion size.Study DesignThis is a technical report describing a novel two-needle approach to lumbar RF medial branch denervation.SettingLarge private interventional pain management institute.MethodsA dual needle placement of two 10-mm active tip RF cannulas separated by 6 mm is used to optimally contact the superior articular process (SAP) from its ventral to dorsal borders, which encompasses the anticipated course of the medial branch nerves.ResultsThe described technique creates a lesion that we estimate to be 11.0-mm wide and 11.6-mm long along the course of the medial branch adjacent to the SAP ensuring adequate coverage and treatment.LimitationsThis report does not encompass a systematic evaluation of the clinical safety and efficacy of the two-needle RFA approach. Future studies will have to assess the long-term efficacy and safety of the approach.ConclusionsThe detailed two-needle approach to lumbar RF medial branch denervation appears to be promising in terms of projected treatment success by coagulating a large volume of tissue, in a cost- and time-efficient manner.

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