Presented at the 2013 AAPM Annual Meeting « Back

Comparative Long-Term Outcomes of Lateral Versus Posterior Approach to Cervical Facet Medial Branch Radiofrequency Ablation

Jianguo Cheng, MD PhD, chengj@ccf.org¹, Larina V. Gutenberg, DO², Jarrod E. Dalton, PhD³, Shingo Yano, MD⁴, Ramsey Saad, MD⁵, Jada J. Reese, MD ABA ABPM⁶, Amaresh Vydyanathan, MD MS⁷, (1) Cleveland Clinic Foundation, Cleveland, Ohio, (2) Premier Pain Consultants, San Antonio, Texas, (3) Cleveland Clinic, Cleveland, Ohio, (4) Cleveland Clinic Pain Medicine Fellowship Program, Cleveland, Ohio, (5) Henry Ford Hospital, Detroit, Michigan, (6) Northside Anesthesia Consultants, Alpharetta, Georgia, (7) Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York

The purpose of this retrospective cohort study is to determine the long term efficacy of the lateral and posterior approaches to cervical facet medial branch radiofrequency ablation (RFA) for the treatment of axial neck pain and/or cervical spondylosis (1-2). With IRB approval, we collected data from 82 patients with axial neck pain and/or cervical spondylosis treated with cervical facet medial branch RFA after positive diagnostic blocks. Of these patients, 38 received the lateral approach and 42 received the posterior approach. The primary outcome, pain reduction expressed as a percentage of patients’ perceived baseline level of pain, was collected at routine visits 1, 3, 6, and 12 months after the RFA procedures. Adjusting for the potential confounders and the intra-subject correlation using an LME model (3-4), we found a statistically significant interaction between RFA treatment and post-procedural time (P=0.0006, Wald test). Our adjusted results indicated that the lateral RFA group experienced higher pain reduction at 6 months and 12 months (P=0.004 and P<0.001, respectively, Wald test, with a Bonferroni-adjusted critical value of 0.0125), while the differences in mean percent pain reduction were not statistically significant at 1 and 3 months (P=0.05 and P=0.06) (5). We concluded that while both approaches of RFA provided significant long lasting pain reduction, the lateral approach seemed to have better outcomes than the posterior approach. However, due to limitations inheritant to retrospective studies, it is not clear whether the observed relationship between RFA technique and pain reduction is an effect that is independent of the baseline characteristics. References: 1) Lord SM, Barnsley L, Wallis BJ, McDonald GJ, Bogduk N. Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain. N Engl J Med 1996;335:1721-1726. 2) Falco FJ, Erhart S, Wargo BW, Bryce DA, Atluri S, Datta S, Hayek SM. Systematic review of diagnostic utility and therapeutic effectiveness of cervical facet joint interventions. Pain Physician. 2009;12:323-44. 3) Pinheiro, J.C. and D.M. Bates, Mixed-effects models in S and S-PLUS. Statistics and computing. 2000, New York: Springer. xvi, 528 p. 4) Pinheiro, J., et al., nlme: Linear and Nonlinear Mixed Effects Models. R package version. 3: p. 1-102. 5) Bonferroni, C.E., Il calcolo delle assicurazioni su gruppi di teste, in Studi in Onore del Professore Salvatore Ortu Carboni. 1935. p. 13-60.

Funding: Supported partially by research grants from NIH/NINDS 1 R01 NS052372.

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