- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03912519
Parallel Versus Perpendicular Technique for Lumbar Medial Branch Radiofrequency Neurotomy
Randomized Trial Comparing Parallel Versus Perpendicular Technique for Lumbar Medial Branch Radiofrequency Neurotomy
Study Overview
Status
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Byron Schneider, MD
- Phone Number: 615-322-0738
- Email: byron.j.schneider@vumc.org
Study Contact Backup
- Name: Blake Fechtel, MD MSc
- Phone Number: 703-647-0143
- Email: fechtel.blake@vumc.org
Study Locations
-
-
Tennessee
-
Nashville, Tennessee, United States, 37212
- Recruiting
- Vanderbilt University Medical Center
-
Contact:
- Byron Schneider, MD
- Phone Number: 615-322-0738
- Email: byron.j.schneider@vumc.org
-
Contact:
- Blake Fechtel, MD MSc
- Phone Number: 703-647-0143
- Email: fechtel.blake@vumc.org
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- aged > 40, capable of understanding and providing consent in English, capable of complying with the outcome instruments used, capable of attending all planned follow up visits
- unilateral or bilateral low back pain of at least 4/10 on Numeric Pain Rating Scale (NPRS) present for at least 2 months that has failed to adequately respond to at least 6 weeks of physical therapy and oral pain medication
- at least 80% improvement on two consecutive lumbar medial branch blocks of no more than a total of 4 lumbar facet joints
- beyond the above stated criteria, the decision to initiate the process of a first medial branch block is based on clinical decision making of the treating physician
- Patient consents to treatment in a shared decision-making process with the treating physician.
Exclusion Criteria:
- Those whose primary complain is lumbar radiculopathy
- Those receiving remuneration for their pain treatment (e.g., disability, worker's compensation).
- Those involved in active litigation relevant to their pain.
- Those unable to read English and complete the assessment instruments.
- Those unable to attend follow up appointments
- The patient is incarcerated.
- History of prior lumbar fusion
- Progressive motor deficit, and/or clinical signs of cauda equina or polyradiculopathy
- History of lumbar steroid injection (epidural steroid injection, sacroiliac joint steroid injection, lumbar facet steroid injection) within the prior 3 months.
- Possible pregnancy or other reason that precludes the use of fluoroscopy.
- Allergy to contrast media or local anesthetics.
- BMI>40.
- Active Systemic inflammatory arthritis (e.g., rheumatoid arthritis, ankylosing spondylitis, lupus).
- Active infection or treatment of infection with antibiotics within the past 7 days.
- Medical conditions causing significant functional disability (e.g., stroke, COPD)
- Chronic widespread pain or somatoform disorder (e.g. fibromyalgia).
- Addictive behavior, severe clinical depression, or psychotic features.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Parallel placement of 16 gauge electrodes
Parallel Group will undergo radiofrequency ablation via the approach described in Spine Intervention Practice Guidelines via 16 gauge electrodes.
Specifically, the target nerve will be targeted with a parallel approach so as the electrode lay parallel to the nerves location within the sulcus formed by the neck of superior articular process and transverse process (or sacral ala for L5) cephalad to the point it is covered by the mamillo-accessory ligament.
|
Parallel technique
|
Active Comparator: Perpendicular placement with 22 gauge electrodes
Perpendicular Group will undergo radiofrequency ablation via the approach described in Spine Intervention Society Practice Guidelines for medial branch blocks, using a 22 gauge electrode.
Specifically, the target nerve will be targeted with a perpendicular approach so as the tip of electrode contact the nerve at some point of it course along the sulcus formed by the neck of superior articular process and transverse process (or sacral ala for L5) cephalad to the point it is covered by the mamillo-accessory ligament.
|
Perpendicular technique
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Modified Clinical Outcome Measurement Brief Instrument (COMBI), Global Impression of Change
Time Frame: Baseline to 12 months
|
Global Impression of Change; Range 0-7 0 = Very much improved 7 = Very much worse
|
Baseline to 12 months
|
Change in Modified Clinical Outcome Measurement Brief Instrument (COMBI), Numeric Rating Scale of Pain Intensity
Time Frame: Baseline to 12 months
|
Numeric Rating Scale of Pain Intensity; Range 0-10 0 = No pain 10 = Pain as bad as you can imagine
|
Baseline to 12 months
|
Change in Modified Clinical Outcome Measurement Brief Instrument (COMBI), Pain
Time Frame: Baseline to 12 months
|
Pain sub-scale as part of the Pain, Enjoyment, General Activity domain of COMBI; Range 0-10 0 = No Pain 10 = Pain as bad as you can image
|
Baseline to 12 months
|
Change in Modified Clinical Outcome Measurement Brief Instrument (COMBI), Enjoyment
Time Frame: Baseline to 12 months
|
Enjoyment sub-scale as part of the Pain, Enjoyment, General Activity domain of COMBI; Range 0-10 0 = Does not interfere 10 = Completely interferes
|
Baseline to 12 months
|
Change in Modified Clinical Outcome Measurement Brief Instrument (COMBI), General Activity
Time Frame: Baseline to 12 months
|
General Activity sub-scale as part of the Pain, Enjoyment, General Activity domain of COMBI; Range 0-10 0 = Does not interfere 10 = Completely interferes
|
Baseline to 12 months
|
Change in Modified Clinical Outcome Measurement Brief Instrument (COMBI), Number of Participants Not Requiring Other Healthcare
Time Frame: Baseline to 12 months
|
Categorical Outcome; ideal would be that patients no longer require other care for the condition for which they were treated.
So, the scoring is simply absolute.
The instrument is neither designed nor intended for more granular analysis, on the grounds that partial reduction in doses required, but nevertheless continuation of other treatment, falls short of indicating a worthwhile, successful outcome (PubMed Identifier: 25312899).
|
Baseline to 12 months
|
Change in Modified Clinical Outcome Measurement Brief Instrument (COMBI), Number of Participants Returning to Work
Time Frame: Baseline to 12 months
|
Categorical outcome; it is very relevant if return to work is achieved.
Failure to return to work is too vexatious an issue, with so many determinants that it is neither efficient nor effective to bother trying to record them (Reference PMID: 25312899).
|
Baseline to 12 months
|
Change in Oswestry Disability Index (ODI)
Time Frame: Baseline to 12 months
|
The questionnaire is designed to give information on how pain is affecting the ability to manage everyday life. The range of scores is 0-100%. 0-20%: "minimal disability": The patient can cope with most living activities. Usually no treatment is indicated apart from advice on lifting sitting and exercise. 21-40%: "moderate disability": The patient experiences more pain and difficulty with sitting, lifting and standing. Travel and social life are more difficult and they may be disabled from work. Personal care, sexual activity and sleeping are not grossly affected and the patient can usually be managed by conservative means. 41-60%: "severe disability": Pain remains the main problem in this group but activities of daily living are affected. 61-80%: "crippled": Back pain impinges on all aspects of the patient's life. 81-100%: These patients are either bed-bound or exaggerating their symptoms. |
Baseline to 12 months
|
Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Byron Schneider, MD, Vanderbilt University Medical Center
- Study Director: Blake Fechtel, MD MSc, Vanderbilt University Medical Center
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 190556
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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