Effectiveness of repeated radiofrequency neurotomy for cervical facet joint pain.

STUDY DESIGN: Retrospective chart review. OBJECTIVES: To determine the success rate and duration of relief of repeat radiofrequency neurotomy (RFN) for cervical facet joint pain. SUMMARY OF BACKGROUND DATA: RFN is an effective but temporary management of cervical facet pain. When pain recurs, RFN is usually repeated, but the outcomes for repeat RFN are not well established. METHODS: Record review of consecutive patients who had an initial successful RFN, recurrence of pain, and then one or more repeat RFN. Responses of repeat RFN were compared with initial RFN for success rates and duration of relief. Success was defined as >/=50% relief of targeted pain and patient sufficiently satisfied with prior RFN to have RFN repeated. RESULTS: There were 14 women and 8 men. Mean age was 47 years (range, 34 to 66 y). Sixty-four RFNs were performed. Mean duration of relief after initial RFN was 12.5 months (range, 3 to 25 mo). Forty-two RFNs were performed after the initial RFN. Forty-one of the 42 RFNs were available to follow-up (98%). Thirty-nine of the 41 RFNs were successful (95%). To date, 11 patients had a series of 2 RFNs performed, 7 had 3, 2 had 4, 1 had 6, and 1 had 7. Twenty-two patients had a second RFN, which was successful in 20 of the 21 available to follow-up (95%) but unsuccessful in 1 (5%). The mean duration of relief in these patients was 12.7 months (range, 3 to 30 mo) and the relief is continuing in 2 patients. Eleven patients had a third RFN, of which 10 (91%) were successful and 1 (9%) was unsuccessful. The mean duration of relief in 8 patients was 9.5 months (range, 3 to 16 mo), and the relief is continuing in the other 2. Four patients had a fourth RFN, which was successful in all 4. The mean duration of relief was 8.75 months (range, 4 to 12 mo). Two patients had a fifth RFN with both having a mean duration of relief of 9 months (11 and 7 mo, respectively). There were 2 patients with a sixth RFN, both were successful, 1 lasted 18 months and in the other relief is continuing. There was 1 patient with a successful seventh RFN, and relief is continuing. The frequency of success and durations of relief remained consistent after each subsequent RFN. CONCLUSIONS: In a carefully selected group of patients with cervical facet joint pain who have been responsive to previous RFN, repeat RFNs are usually successful.

Effectiveness of repeated radiofrequency neurotomy for lumbar facet pain.

STUDY DESIGN: Retrospective chart review. OBJECTIVES: To determine the success rate and duration of relief of repeat radiofrequency neurotomy for lumbar facet joint pain. SUMMARY OF BACKGROUND DATA: Radiofrequency neurotomy is an effective but temporary management of lumbar facet pain. When pain recurs, radiofrequency neurotomy is usually repeated, but the outcome and duration of relief for repeat radiofrequency neurotomies are unknown. METHODS: Record review of consecutive patients who had an initial successful radiofrequency neurotomy, subsequent recurrence of pain, and then repeat radiofrequency neurotomy. Responses of repeat radiofrequency neurotomies were compared with initial radiofrequency neurotomy for success rates and duration of relief. RESULTS: There were 16 women and 4 men. Mean age was 48 years (range, 26-63). Radiofrequency neurotomy denervated one segment in two patients, two segments in 16 patients, and three or more in two patients. There were 10 bilateral and 10 unilateral radiofrequency neurotomies. Mean duration of relief after initial radiofrequency neurotomy was 10.5 months (range, 4-19). To date, two patients had a series of two radiofrequency neurotomies performed, six had three, five had four, three had five, and four had seven or more. Twenty patients had a second radiofrequency neurotomy, which was successful in 17 (85%) but unsuccessful in two. The mean duration of relief in 16 of these 17 patients was 11.6 months (range, 6-19), and relief is continuing in one. Sixteen patients had a third radiofrequency neurotomy, of which 15 were successful and one was unsuccessful. The mean duration of relief in nine of the 15 was 11.2 months (range, 5-23), and relief is continuing in the other six. Eight patients had a fourth radiofrequency neurotomy, which was successful in seven but unsuccessful in one. The mean duration of relief was 9 months (range, 5-14) in three patients, and relief is continuing in the other four. None of these differences is significant. The frequency of success and durations of relief remained consistent after each subsequent radiofrequency neurotomy. CONCLUSIONS: Repeated radiofrequency neurotomies are an effective long-term palliative management of lumbar facet pain. Each radiofrequency neurotomy had a mean duration of relief of 10.5 months and was successful more than 85% of the time.