Thoracic Zygapophysial Joint Thermal Neurotomy: A Cohort Revealing Additional Outcomes by Specific Joint Groupings

Objective Thoracic spinal pain is common, and patients with this type of pain have limited therapeutic options. The cohort in this study received diagnostic intra-articular zygapophysial joint injections leading to thermal neurotomy to the medial branch nerves to demonstrate improved pain as well as physical and psychological function. Design A consecutive cohort from 2012 to 2018 with retrospective analysis of prospectively gathered data. Setting A private multidisciplinary pain clinic with referrals from primary care. Results Forty-six complete data sets from 39 patients were found using a pre-procedure and 3-month post-procedure questionnaire. Further follow-up results were found for the dual primary outcomes of duration of ≥50% relief using a numeric rating scale (NRS) for the entire group. The group was then divided into three subgroups of T1/2–T3/4, T4/5–T8/9, and T9/10–T12/L1. Success rates of 63% for ≥3 months of ≥50% relief and 46% for ≥6 months of ≥50% relief were found, for an average duration of 7.8 months. Group mean change in the NRS was 6.7, decreasing to 4.3 (P<0.0001). For the first time, there are data showing that the three groups of T1/2–T3/4, T4/5–T8/9, and T9/10–T12/L1 responded equally. Secondary outcomes of physical and psychological function using the Functional Rating Index (FRI) and the Depression Anxiety Stress Scale (DASS) all showed significant improvements with small to moderate effect sizes and with all achieving >36% improvement in scores. Conclusion This cohort demonstrates that there is a pragmatic diagnostic and therapeutic option available for patients with thoracic zygapophysial joint pain that can achieve 50–100% of pain relief in 63% of patients with improved physical and psychological function.

Endoscopic rhizotomy for chronic lumbar zygapophysial joint pain

Background Chronic lumbar zygapophysial joint pain is a common cause of chronic low back pain. Percutaneous radiofrequency ablation (RFA) is one of the effective management options; however, the results from the traditional RFA need to be improved in certain cases. The aim of this study is to investigate the effect of percutaneous radiofrequency ablation under endoscopic guidance (ERFA) for chronic low back pain secondary to facet joint arthritis. Methods This is a prospective study enrolled 60 patients. The cases were randomized into two groups: 30 patients in the control group underwent traditional percutaneous radiofrequency ablation, others underwent ERFA. The lumbar visual analog scale (VAS), MacNab score, and postoperative complications were used to evaluate the outcomes. All outcome assessments were performed at postoperative 1 day, 1 month, 3 months, 6 months, and 12 months. Results There was no difference between the two groups in preoperative VAS (P > 0.05). VAS scores, except the postoperative first day, in all other postoperative time points were significantly lower than preoperative values each in both groups (P < 0.05). There was no significant difference between the two groups in VAS at 1 day, 1 month, and 3 months after surgery (P > 0.05). However, the EFRA demonstrated significant benefits at the time points of 3 months and 6 months (P > 0.05). The MacNab scores of 1-year follow-up in the ERFA group were higher than that in the control group (P < 0.05). The incidence of complications in the ERFA group was significantly less than that in the control group (P < 0.05). Conclusions ERFA may achieve more accurate and definite denervation on the nerves, which leads to longer lasting pain relief.