A Shortened Radiofrequency Denervation Method for Cervical Zygapophysial Joint Pain Based on Ultrasound Localization of the Nerves

Authors

  • Andreas Siegenthaler MD,

    Corresponding author
    1. University Department of Anesthesiology and Pain Therapy, University of Bern, Inselspital, Bern, Switzerland
      Andreas Siegenthaler, MD, University Department of Anesthesiology and Pain Therapy, University of Bern, Inselspital, Bern, 3010, Switzerland. Tel: 0041316323027; Fax: 0041316323028; E-mail: andisiegenthaler@gmail.com.
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  • Urs Eichenberger MD,

    1. University Department of Anesthesiology and Pain Therapy, University of Bern, Inselspital, Bern, Switzerland
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  • Michele Curatolo MD, PhD

    1. University Department of Anesthesiology and Pain Therapy, University of Bern, Inselspital, Bern, Switzerland
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  • Disclosure: The authors report no conflict of interest.

Andreas Siegenthaler, MD, University Department of Anesthesiology and Pain Therapy, University of Bern, Inselspital, Bern, 3010, Switzerland. Tel: 0041316323027; Fax: 0041316323028; E-mail: andisiegenthaler@gmail.com.

Abstract

Objective.  Radiofrequency neurotomy is a recognized treatment for cervical zygapophysial joint pain. In several studies, the method has provided complete pain relief in 60–70% of the patients for approximately 9 months. The validated technique has the disadvantage of procedural times of 2–4 hours because several lesions are performed to take into account the variable nerve course. We tested the hypothesis that ultrasound localization of the nerves would enable us to reduce the number of lesions performed, while reaching the benchmark of at least 80% pain relief in 80% of patients with a median duration of 35 weeks, as achieved by a previous investigation using the standard method.

Interventions.  We prospectively studied 15 consecutive patients with diagnosed cervical zygapophysial joint pain. They were treated using a shortened radiofrequency procedure under fluoroscopic control, based on previous ultrasound localization of the joint supplying nerves, with only two thermal lesions performed per nerve. Successful treatment was defined as at least 80% pain relief in the visual analog scale as compared with pretreatment. Follow-up was performed until 12 months after treatment.

Results.  Of the 15 patients, 14 were successfully treated (93%, 95% confidence interval [CI] 80–100%) with a median time of pain relief of 44 weeks. At 6 and 12 months, 13 (87%, 95% CI 70–100%) and 6 patients (40%, 95% CI 15–65%) reported successful treatment, respectively. The median duration of the procedure was 35 minutes.

Conclusion.  In patients with cervical zygapophysial joint pain, radiofrequency denervation according to a shortened protocol based on ultrasound localization of the nerves reached the benchmark of the standard technique.

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