Denervation Techniques for Chronic Low Back Pain due to Lumbar Facet Joint Arthropathy: A Comparison Between Radiofrequency and Endoscopic Neurotomy
Anas Afifi, Michel Paul Johan Teuben, Alba Shehu, Stavros Oikonomidis, Mohammed Abujarad, Mathis Ringe, Rolf Sobottke, Mohamad Agha MahmoudABSTRACT
Purpose
Radiofrequency neurotomy (RFN) of the lumbar medial branch is the standard of care for facet joint arthropathy‐related chronic low back pain (CLBP). However, endoscopic neurotomy (EN) has also recently been adopted as a feasible treatment option for CLBP. The increasing population of patients with cardiac implantable electronic devices (CIEDs) highlights the need for alternative denervation methods to avoid device interference. We propose that both RFN and EN are effective for CLBP, with EN offering a safe option for patients with CIEDs and therapy‐resistant aberrant innervation.
Methods
Patients with facet joint arthropathy‐related CLBP who were treated between 01.01.2016 and 31.12.2019 were prospectively included and grouped as RFN or EN based on treatment. Over a 12‐month period, the following outcomes were studied: Core Outcome Measures Index for the back (COMI‐back), Visual Analogue Scale (VAS), complications, and costs.
Results
Sixty‐five patients (35 female) with a median age of 62 years were included. Prior to the intervention, patients had a median COMI‐back of 8.6 (IQR: 7.7–9.0) and a median VAS score of 8.0 (IQR: 7.0–9.0). After intervention, the VAS score dropped significantly for both groups. Thereafter, pain scores rose in the EN group, whereas VAS levels in the RFN group remained unaltered. Complication rates were significantly lower after RFN compared with EN patients ( p < 0.007). Total costs were significantly lower for the RFN group ( p < 0.01).
Conclusion
In conclusion, this prospective study shows that both EN and percutaneous multilevel RFN are safe and effective treatments for facet joint arthropathy‐associated CLBP. RFN is preferred as the first treatment option for uncomplicated CLBP due to its lower invasiveness, while EN is suitable as an alternative for patients with CIEDs and those with therapy‐resistant aberrant innervation or anatomical variations.