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Open facet joint denervation as an adjunct in patients undergoing posterior lumbar decompression for spinal stenosis-a single blinded randomized controlled trial.

ABSTRACT: Background:Facet radiofrequency denervation is a prevalent procedure used to try and relieve back pain. Despite the increasing use of this treatment, its effectiveness has been questioned. In consideration of the conflicting reports in the literature, we sought to conduct a trial to study the short-term effect of facet denervation in patients undergoing lumbar laminectomy(s) to determine the short-term effect of adding facet denervation to patients undergoing lumbar laminectomy(s) where the anatomy was exposed, allowing an open technique to be used for the denervation. Methods:Sixty patients with a diagnosis of degenerative lumbar spinal stenosis who complained of neurogenic claudication and back pain for at least 3 months were randomized to undergo a lumbar laminectomy(s) either with or without facet joint denervation. Pain and self-reported function using a 10 cm visual analogue scale (VAS) and the Roland-Morris Disability Questionnaire (RMDQ) were measured before surgery and at patients' 6-, 12- and 24-week follow-up clinic visit. Various parametric and non-parametric tests including the Chi-square, independent samples t-tests, the Mann Whitney U, Wilcoxon sign ranks, one-way ANOVA with a Bonferroni post hoc test were used to analyze the data. The RMDQ scores were analyzed between groups and within groups over time. Results:No differences in pain or functional ability were seen between groups. Both groups significantly improved in both pain and function from baseline to follow up times. Conclusions:Our findings do not support the addition of facet denervation for short-term treatment of back pain in patients undergoing lumbar laminectomy(s) for spinal stenosis within our study design.

SUBMITTER: Faqeeh A

PROVIDER: S-EPMC6626737 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

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Open facet joint denervation as an adjunct in patients undergoing posterior lumbar decompression for spinal stenosis-a single blinded randomized controlled trial.

Faqeeh Ali A Yen David D

Journal of spine surgery (Hong Kong) 20190601 2

<h4>Background</h4>Facet radiofrequency denervation is a prevalent procedure used to try and relieve back pain. Despite the increasing use of this treatment, its effectiveness has been questioned. In consideration of the conflicting reports in the literature, we sought to conduct a trial to study the short-term effect of facet denervation in patients undergoing lumbar laminectomy(s) to determine the short-term effect of adding facet denervation to patients undergoing lumbar laminectomy(s) where ...[more]

PMID: 31380480

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Project description:What we already know about this topicWHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: With facet interventions under scrutiny, the authors' objectives were to determine the effectiveness of different lumbar facet blocks and their ability to predict radiofrequency ablation outcomes.MethodsA total of 229 participants were randomized in a 2:2:1 ratio to receive intraarticular facet injections with bupivacaine and steroid, medial branch blocks, or saline. Those with a positive 1-month outcome (a 2-point or more reduction in average pain score) and score higher than 3 (positive satisfaction) on a 5-point satisfaction scale were followed up to 6 months. Participants in the intraarticular and medial branch block groups with a positive diagnostic block (50% or more relief) who experienced a negative outcome proceeded to the second phase and underwent radiofrequency ablation, while all saline group individuals underwent ablation. Coprimary outcome measures were average reduction in numerical rating scale pain score 1 month after the facet or saline blocks, and average numerical rating scale pain score 3 months after ablation.ResultsMean reduction in average numerical rating scale pain score at 1 month was 0.7 ± 1.6 in the intraarticular group, 0.7 ± 1.8 in the medial branch block group, and 0.7 ± 1.5 in the placebo group; P = 0.993. The proportions of positive blocks were higher in the intraarticular (54%) and medial branch (55%) groups than in the placebo group (30%; P = 0.01). Radiofrequency ablation was performed on 135 patients (45, 48, and 42 patients from the intraarticular, medial branch, and saline groups, respectively). The average numerical rating scale pain score at 3 months was 3.0 ± 2.0 in the intraarticular, 3.2 ± 2.5 in the medial branch, and 3.5 ± 1.9 in the control group (P = 0.493). At 3 months, the proportions of positive responders in the intraarticular, medial branch block, and placebo groups were 51%, 56%, and 24% for the intraarticular, medial branch, and placebo groups, respectively (P = 0.005).ConclusionsThis study establishes that facet blocks are not therapeutic. The higher responder rates in the treatment groups suggest a hypothesis that facet blocks might provide prognostic value before radiofrequency ablation.

Project description:BackgroundWe aim to investigate associations between preoperative radiological findings of lumbar foraminal stenosis with clinical outcomes after posterior microsurgical decompression in patients with predominantly central lumbar spinal stenosis (LSS).MethodsThe study was an additional analysis in the NORDSTEN Spinal Stenosis Trial. In total, 230 men and 207 women (mean age 66.8 (SD 8.3)) were included. All patients underwent an MRI including T1- and T2-weighted sequences. Grade of foraminal stenosis was dichotomized into none to moderate (0-1) and severe (2-3) category using Lee's classification system. The Oswestry Disability Index (ODI), Zurich Claudication Questionnaire (ZCQ), and numeric rating scale (NRS) for back and leg pain were collected at baseline and at 2-year follow-up. Primary outcome was a reduction of 30% or more on the ODI score. Secondary outcomes included the mean improvement on the ODI, ZCQ, and NRS scores. We performed multivariable regression analyses with the radiological variates foraminal stenosis, Pfirrmann grade, Schizas score, dural sac cross-sectional area, and the possible plausible confounders: patients' gender, age, smoking status, and BMI.ResultsThe cohort of 437 patients presented a high degree of degenerative changes at baseline. Of 414 patients with adequate imaging of potential foraminal stenosis, 402 were labeled in the none to moderate category and 12 in the severe category. Of the patients with none to moderate foraminal stenosis, 71% achieved at least 30% improvement in ODI. Among the patients with severe foraminal stenosis, 36% achieved at least 30% improvement in ODI. A significant association between severe foraminal stenosis and less chance of reaching the target of 30% improvement in the ODI score after surgery was detected: OR 0.22 (95% CI 0.06, 0.83), p=0.03. When investigating outcome as continuous variables, a similar association between severe foraminal stenosis and less improved ODI with a mean difference of 9.28 points (95%CI 0.47, 18.09; p=0.04) was found. Significant association between severe foraminal stenosis and less improved NRS pain in the lumbar region was also detected with a mean difference of 1.89 (95% CI 0.30, 3.49; p=0.02). No significant association was suggested between severe foraminal stenosis and ZCQ or NRS leg pain.ConclusionIn patients operated with posterior microsurgical decompression for LSS, a preoperative severe lumbar foraminal stenosis was associated with higher proportion of patients with less than 30% improvement in ODI.Trial registrationThe study is registered at ClinicalTrials.gov (22.11.2013) under the identifier NCT02007083.

Dataset Information

Open facet joint denervation as an adjunct in patients undergoing posterior lumbar decompression for spinal stenosis-a single blinded randomized controlled trial.

Publications

Open facet joint denervation as an adjunct in patients undergoing posterior lumbar decompression for spinal stenosis-a single blinded randomized controlled trial.

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