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      Relationship between paravertebral muscle twitching and long-term effects of radiofrequency medial branch neurotomy

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          Abstract

          Background

          To achieve a prolonged therapeutic effect in patients with lumbar facet joint syndrome, radiofrequency medial branch neurotomy (RF-MB) is commonly performed. The purpose of this study was to evaluate the prognostic value of paravertebral muscle twitching when performing RF-MB in patients with lumbar facet joint syndrome.

          Methods

          We collected and analyzed data from 68 patients with confirmed facet joint syndrome. Sensory stimulation was performed at 50 Hz with a 0.5 V cut-off value. Patients were divided into 3 groups according to the twitching of the paravertebral muscle during 2 Hz motor stimulation: ‘Complete’, when twitching was observed at all needles; ‘Partial’, when twitching was present at 1 or 2 needles; and ‘None’, when no twitching was observed. The relationship between the long-term effects of RF-MB and paravertebral muscle twitching was analyzed.

          Results

          The mean effect duration of RF-MB was 4.6, 5.8, and 7.0 months in the None, Partial, and Complete groups, respectively ( P = 0.47). Although the mean effect duration of RF-MB did not increase significantly in proportion to the paravertebral muscle twitching, the Complete group had prolonged effect duration (> 6 months) than the None group in subgroup analysis. ( P = 0.03).

          Conclusions

          Paravertebral muscle twitching while performing lumbar RF-MB may be a reliable predictor of long-term efficacy when sensory provocation under 0.5 V is achieved. However, further investigation may be necessary for clarifying its clinical significance.

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          The effect of chronic low back pain on size and contraction of the lumbar multifidus muscle.

          Tracy Wallwork, Warren R Stanton, Matt Freke … (2009)
          Decreases in the size of the multifidus muscle have been consistently documented in people with low back pain. Recently, ultrasound imaging techniques have been used to measure contraction size of the multifidus muscle, via comparison of the thickness of the muscle at rest and on contraction. The aim of this study was to compare both the size (cross-sectional area, CSA) and the ability to voluntarily perform an isometric contraction of the multifidus muscle at four vertebral levels in 34 subjects with and without chronic low back pain (CLBP). Ultrasound imaging was used for assessments, conducted by independent examiners. Results showed a significantly smaller CSA of the multifidus muscle for the subjects in the CLBP group compared with subjects from the healthy group at the L5 vertebral level (F=29.1, p=0.001) and a significantly smaller percent thickness contraction for subjects of the CLBP group at the same vertebral level (F=6.6, p=0.02). This result was not present at other vertebral levels (p>0.05). The results of this study support previous findings that the pattern of multifidus muscle atrophy in CLBP patients is localized rather than generalized but also provided evidence of a corresponding reduced ability to voluntarily contract the atrophied muscle.
          Article 0 comments Cited 93 times – based on 0 reviews     Review now
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            Randomized trial of radiofrequency lumbar facet denervation for chronic low back pain.

            Guido M Voets, Lilian Kessels, M Y Hoven … (1999)
            A prospective double-blind randomized trial in 31 patients. To assess the clinical efficacy of percutaneous radiofrequency denervation of the lumbar zygapophysial joints in reducing pain, functional disability, and physical impairment in patients with back pain originating from the lumbar zygapophysial joints. Chronic low back pain is a major health problem in the industrialized world. A treatment option is percutaneous radiofrequency denervation of the lumbar zygapophysial joints. Its clinical efficacy has never been formally tested in a controlled trial. Thirty-one patients with a history of at least 1 year of chronic low back pain were selected on the basis of a positive response to a diagnostic nerve blockade and subsequently randomly assigned to one of two treatment groups. Each patient in the radiofrequency treatment group (15 patients) received an 80 C radiofrequency lesion of the dorsal ramus of the segmental nerve roots L3, L4, and L5. Patients in the control group (n = 16) underwent an the same procedure but without use of a radiofrequency current. Both the treating physician and the patients were blinded to the group assignment. Before treatment, physical impairment, rating of pain, the degree of disability, and quality of life were assessed by a blinded investigator. Eight weeks after treatment, there were 10 success patients in the radiofrequency group (n = 15) and 6 in the sham group (n = 16). The unadjusted odds ratio was 3.3 (P = 0.05, not significant), and the adjusted odds ratio was 4.8 (P < 0.05, significant). The differences in effect on the visual analog scale scores, global perceived effect, and the Oswestry disability scale were statistically significant. Three, 6, and 12 months after treatment, there were significantly more success patients in the radiofrequency group compared with the sham group. Radiofrequency lumbar zygapophysial joint denervation results in a significant alleviation of pain and functional disability in a select group of patients with chronic low back pain, both on a short-term and a long-term basis.
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              Efficacy and validity of radiofrequency neurotomy for chronic lumbar zygapophysial joint pain.

              P Dreyfuss, K Pauza, N Bogduk … (2000)
              A prospective audit. To establish the efficacy of lumbar medial branch neurotomy under optimum conditions. Previous reports of the efficacy of lumbar medial branch neurotomy have been confounded by poor patient selection, inaccurate surgical technique, and inadequate assessment of outcome. Fifteen patients with chronic low back pain whose pain was relieved by controlled, diagnostic medial branch blocks of the lumbar zygapophysial joints, underwent lumbar medial branch neurotomy. Before surgery, all were evaluated by visual analog scale and a variety of validated measures of pain, disability, and treatment satisfaction. Electromyography of the multifidus muscle was performed before and after surgery to ensure accuracy of the neurotomy. All outcome measures were repeated at 6 weeks, and 3, 6, and 12 months after surgery. Some 60% of the patients obtained at least 90% relief of pain at 12 months, and 87% obtained at least 60% relief. Relief was associated with denervation of the multifidus in those segments in which the medial branches had been coagulated. Prelesion electrical stimulation of the medial branch nerve with measurement of impedance was not associated with outcome. Lumbar medial branch neurotomy is an effective means of reducing pain in patients carefully selected on the basis of controlled diagnostic blocks. Adequate coagulation of the target nerves can be achieved by carefully placing the electrode in correct position as judged radiologically. Electrical stimulation before lesioning is superfluous in assuring correct placement of the electrode.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Korean J Pain
                Journal ID (iso-abbrev): Korean J Pain
                Journal ID (publisher-id): KJP
                Title: The Korean Journal of Pain
                Publisher: The Korean Pain Society
                ISSN (Print): 2005-9159
                ISSN (Electronic): 2093-0569
                Publication date (Print): October 2017
                Publication date (Electronic): 29 September 2017
                Volume: 30
                Issue: 4
                Pages: 296-303
                Affiliations
                [1 ]Department of Anesthesiology and Pain Medicine, Gangnam Severance Hospital, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
                [2 ]Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea.
                Author notes
                Correspondence to: Ji Won An. Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea. Tel: +82-2-2019-3520, Fax: +82-2-3463-0940, anzi1md@ 123456naver.com
                Article
                DOI: 10.3344/kjp.2017.30.4.296
                PMC ID: 5665742
                PubMed ID: 29123625
                SO-VID: 359b5675-f7c8-4e77-aa61-91ea585c2f7c
                Copyright © Copyright © The Korean Pain Society, 2017
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 10 April 2017
                Date revision received : 06 September 2017
                Date accepted : 06 September 2017
                Categories
                Subject: Original Article

                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: ablation technique,facet joint,fasciculation,innervation,lower back pain,prognosis,radiofrequency catheter ablation
                Data availability:
                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: ablation technique, facet joint, fasciculation, innervation, lower back pain, prognosis, radiofrequency catheter ablation

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