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Efficacy of Cervical Facet Joint Radiofrequency Ablation Using a Multitined Cannula, a Technical Note, and
Andrea Künzle1, Sander M J van Kuijk2, Eva Koetsier1
1Pain Management Center, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.
Background:
Chronic cervical facet joint pain is a leading cause of pain and disability. In patients nonresponsive to conservative treatment, cervical facet radiofrequency ablation (RFA) has shown to be efficacious. However, the conventional RFA technique can be cumbersome. A novel RFA technique with a multitined cannula allows for a lateral approach and represents an attractive alternative option for cervical facet RFA. It offers a potentially shorter, less cumbersome procedure, with consequently less x-ray exposure and patient discomfort than the conventional cervical RFA.
Objectives:
To describe the novel RFA technique using the lateral approach with the multitined cannula at the cervical facet joints and to assess its efficacy in chronic cervical facet joint pain.
Study Design:
This is a single-center observational study.
Setting:
Interventional Pain Management Center, Switzerland.
Methods:
The aim of this study is to describe the RFA technique using the lateral approach with the multitined cannula at the cervical facet joints and to assess its efficacy in chronic cervical facet joint pain. Eligible adult patients with chronic (> 3 months) cervical facet joint pain refractory to conservative treatment and confirmed by dual positive medial branch blocks, received a fluoroscopic-guided cervical facet RFA treatment using the multitined cannula. The primary outcome was pain relief. Secondary outcome measures included the proportion of patients reporting a >= 30% reduction of pain intensity 2 months after RFA, patient global impression of change (PGIC), need for pain medication, sleep quality, and patient satisfaction.
Results:
We included 26 patients. The patients showed a clinically meaningful and significant pain relief at 2 months after cervical facet RFA (mean Numeric Rating Scale of 7.5 [1.9] at baseline to 4.2 [2.4]) and 58% of the patients reported >= 30% reduction of pain. An improvement on the PGIC was reported by 88.2% of the patients. No severe side effects or complications were observed.
Limitations:
Key limitations of our study were the relatively small sample size, the lack of a control group, and a relatively short-term follow-up duration.
Conclusions:
Our results suggest that cervical facet joint RFA using the novel technique with the multitined cannula results in significant pain reduction and improvement on the PGIC. While the conventional technique requires multiple ablations at each target level, the RFA with the multitined needle requires only a singular ablation, likely sparing time, radiation dose, discomfort, and costs. Our results merit consideration of replacement of the conventional technique with the novel technique using the multitined cannula. However, larger-scale clinical trials with an adequate long-term follow-up period are needed to prove the efficacy of RFA using the multitined cannula in cervical facet joint pain.
