- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01300715
An Alternative Technique for Lumbar Medial Branch Radiofrequency: Comparison With the Empirical Technique (MBRF LBP)
In spite that variable techniques for lumbar MBRF exists, the tunnel vision technique is widely recommended for exact radiofrequency needle placement. However, this method uses the concept of a steep caudocephalad axial tilt of the fluoroscopy beam, which result in unusual appearance of vertebral structures and a long distance from skin to the target site. In our institution, therefore, the investigators have used a modified method that is easy and safe to place RF needle parallel to the lumbar medial branch in oblique fluoroscopic view.
Accordingly, our objectives were to evaluate our modified technique for lumbar MBRF, comparing with the tunnel vision technique, and additionally to assess complications with respect to these two techniques.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
The zygapophysial (facet) joint pain has been a challenging condition for pain specialists since the 20th century. According to the previous reports, degenerative changes of facet joint account for 10% - 15% of the cases with chronic low back pain. However, it is a major source of frustration that there is no definitive standard to document a clinical diagnosis and few validated treatment about lumbar facet joint pain.
Although it has been a subject of debate how best to select patients, radiofrequency (RF) neurotomy is frequently performed procedure for patients with lumbar facet generated pain. Lumbar medial branch radiofrequency (MBRF) is assumed to be effective and safe treatment for lumbar facet joint pain with 1.0% rate of minor complications per lesion site. The rationale and efficacy of lumbar MBRF would depend on the use of meticulous radiofrequency (RF) needle placement with stringent patient selection.
In spite that variable techniques for lumbar MBRF exists, the tunnel vision technique is widely recommended for exact RF needle placement. However, this method uses the concept of a steep caudocephalad axial tilt of the fluoroscopy beam, which result in unusual appearance of vertebral structures and a long distance from skin to the target site. In our institution, therefore, the investigators have used a modified method that is easy and safe to place RF needle parallel to the lumbar medial branch in oblique fluoroscopic view.
Accordingly, our objectives were to evaluate our modified technique for lumbar MBRF, comparing with the tunnel vision technique, and additionally to assess complications with respect to these two techniques.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Kyonggi-do
-
Sungnam, Kyonggi-do, Korea, Republic of, 463-707
- Recruiting
- Seoul National University Bundang Hospital
-
Contact:
- Pyung-Bok Lee, M.D., Ph.D.
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Chronic low back pain patients (pain duration > 6 months) who had not responded to previous treatment, underwent screening medial branch blocks (MBBs) using 0.5% levobupivacaine hydrochloride (Chirocaine®, Abbott Korea Ltd, Seoul, Republic of Korea) 0.5 mL at each of the standard target points.8 Patients that achieved at least 80% pain relief by screening MBBs underwent controlled comparative local anesthetic blocks using 1% lidocaine (0.5 mL) and 0.5% levobupivacaine (0.5 mL). Those that achieved greater than 80% pain relief following double blocks were eligible for lumbar MBRF, but those with prolonged responses to screening or dual-controlled comparative MBBs were not considered eligible.
Exclusion Criteria:
- Duration of low back pain < 6 mo
- Single diagnostic block
- Prolonged responses to screening or dual-controlled comparative MBBs
- Discogenic pain verified by controlled discography
- Evidence of radiculopathy, as determined by history, physical examination, and radiologic studies
- Structural lumbar spinal deformity
- Rapidly worsening pain, numbness, weakness, hyperreflexia, changes in bladder function, and other neurological symptoms which should prompt a reevaluation and surgical evaluation.
- Previous back surgery
- Severe psychiatric illness
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: MBRF
|
the classic tunnel vision technique versus the alternative technique
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
numerical rating scale (NRS)(1)
Time Frame: change from baseline in NRS at 4 weeks
|
Preprocedure low-back pain recorded on a 0 to 10 numerical rating scale (NRS)versus NRS at one-month follow-up visits
|
change from baseline in NRS at 4 weeks
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Oswestry Disability Index (ODI)(1)
Time Frame: change from baseline in ODI at 4 weeks
|
Preprocedure Oswestry Disability Index (ODI) versus ODI at one-month follow-up visit
|
change from baseline in ODI at 4 weeks
|
time to complete the procedures
Time Frame: on procedure
|
Time required to complete each procedure (skin-to-lesion time, separately)
|
on procedure
|
7-point global perceived effect (GPE) scale about low back pain (1)
Time Frame: change from baseline in GPE scale at 4 weeks after the procedure
|
|
change from baseline in GPE scale at 4 weeks after the procedure
|
Complication (1)
Time Frame: at one-month follow-up visit
|
Complications associated to the procedures
|
at one-month follow-up visit
|
medication reduction (1)
Time Frame: baseline and 4 weeks
|
doses of preprocedural analgesics versus postprocedural medication reduction
|
baseline and 4 weeks
|
NRS(3)
Time Frame: Change from baseline in NRS at 12 weeks
|
preprocedural low back pain recorded on a 0 to 10 numerical rating scale versus NRS at a 3-month follow-up visit
|
Change from baseline in NRS at 12 weeks
|
procedure-related pain of numerical rating scale (NRS)
Time Frame: after 10 minutes following the procedure
|
Procedure-related pain as determined by NRS is recorded immediately after lumbar medial branch radiofrequency.
|
after 10 minutes following the procedure
|
Oswestry Disability Index (ODI)(3)
Time Frame: change from baseline in ODI at 12 weeks
|
Preprocedure Oswestry Disability Index (ODI) versus ODI at three-month follow-up visit
|
change from baseline in ODI at 12 weeks
|
7-point global perceived effect (GPE) scale about low back pain (3)
Time Frame: change from baseline in GPE scale at 12 weeks after the procedure
|
|
change from baseline in GPE scale at 12 weeks after the procedure
|
Complication (3)
Time Frame: at three-month follow-up visit
|
Complications associated to the procedures
|
at three-month follow-up visit
|
medication reduction (3)
Time Frame: baseline and 12 weeks
|
doses of preprocedural analgesics versus postprocedural medication reduction
|
baseline and 12 weeks
|
Volume of local anesthetic
Time Frame: on procedure
|
Volume of local anesthetic required for superficial and deep anesthesia, separately
|
on procedure
|
Collaborators and Investigators
Study record dates
Study Major Dates
Study Start
Primary Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- MBRF
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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