• Zachary L McCormick, Aaron Conger, Richard Kendall, Graham Wagner, A Michael Henrie, Madelaine Littell, Beau P Sperry, Russel Petersen, Amanda N Cooper, Masaru Teramoto, and Taylor R Burnham.
• Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT 84108, United States.
• Pain Med. 2023 Dec 1; 24 (12): 131813311318-1331.

BackgroundLumbar medial branch radiofrequency ablation (LRFA) and intraarticular facet steroid injections (FJI) are commonly performed for recalcitrant facet joint-mediated pain. However, no study has compared clinical outcomes of the two treatments in patients selected using dual medial branch blocks (MBBs) with an 80% relief threshold.ObjectiveCompare the effectiveness of cooled LRFA (C-LRFA) to FIJ as assessed by pain and functional improvements.DesignProspective randomized comparative trial.MethodsPatients with dual MBB-confirmed facet joint-mediated pain were randomized to receive C-LRFA or FIJ. Outcomes were assessed at 1, 3, 6, and 12 months. The primary outcome was ≥50% improvement in numerical pain rating scale (NPRS) score at 3 months. Secondary outcomes included ≥30% Oswestry Disability Index (ODI) improvement and Patient Global Impression of Chance (PGIC) ≥6 points, among others. Data were analyzed using contingency tables and mixed-effects logistic regression models.ResultsOf 1128 patients screened, 32 met eligibility criteria, were randomized, and received their allocated study treatment. In total, 20 (62.5%) and 12 (37.5%) participants received C-LRFA and FIJ, respectively. In the C-LRFA group, 70% (95% CI 48-85), 55% (95% CI 34-74), and 45% (95% CI 26-66) of participants met the NPRS responder definition, compared to 25% (95%CI 9-53), 25% (95% CI 9-53), and 17% (95% CI 5-45) in the FJI group at 3, 6, and 12 months, respectively (P = .014 at 3 months). The PGIC responder proportion was higher in the C-LRFA compared to FJI group at 3 and 6 months (P < .05).ConclusionsC-LRFA demonstrated superior success rates compared to FJI across pain and functional outcome domains.Trial Registration DetailsClinicalTrials.gov (NCT03614793); August 3, 2018.© The Author(s) 2023. Published by Oxford University Press on behalf of the American Academy of Pain Medicine.

32 keywords...

hide…